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HomeMy WebLinkAbout1612 Scarborough Dr - Applications/Water Heater - 10/22/201310/20/2010 04:27 #0977 P.001 /001 Pla ning, Developm t Transportation Cciity . of t`o�j 281 FortCollins, N. College Ave P.O. CO 80524 Box 580 I�Vr 1.�ns �r Phone 970-416-2740 �ax 224-6134 OVER -THE -MOUNTER PERMITS gNLY This application is to be used to ap Cl Demolition (interior non-structural) ply for; the following permits ❑ Electrical Alteration (not ser Dnly (check all that Ace change) 13 Gaffs apply). ❑ Air Conditioning Lighter ❑ Gas Log ❑ Heating knit ❑ I�swn Sprinkler Mobile Home replacement Line ❑ Wood/Pellet Stove Roofing ❑ Sewer (must be EPA certified, fine ❑ Photo -voltaic . provide make, model and 0 Ventilation Vater Heater ❑ W ter manufacturer). Complete all apolleabie informatioi i on the application. Inci:Dmplete applications will not be accepted_ Application # MCP D For office rise only ]ob Site Address (required va ofConstrucxio� (labor, materials, profit).1 1$)050- propertyQwner Name.. Applicant Nam.. � 11 • � .U• � •L1 i1�W' �1■ Contractor City of Ft Gjins Sales T # Are sales tax mwbwIsragrmedbya/! Are is alis a residential commercial pro' sidential ❑ If residential, is it: Iningie Family Demched ❑ Condo/tow ❑ Multifamily (al artment)!Cl Garage If commercial, is it ❑ Bank ❑ Bar 0 Church 13 HoW/Mote ❑ Restaurant Cl other (explain) is this building 50 years of age or ? ❑ Yes ❑ No If yt w at if this is for a demon ion permit, year was the building a If prior to 1975, you will need an am ewilerlt to submit *17;7a • • • State Zip Phone 4 srMXO z7-i -�� (State I Zip Phone -1co '90521�Lo a-70,ao •Ul (state I Zip Phone taxes here or bi report? © H0r.d G'R(4 with your trust account? es ❑ :No � (single family all ❑ ical office ❑ yo may, need to cor tru ? h ,sapplkation. *If lawn sprinkler/baddlow PreverSer, njust list licensed plumber. If Oust me AX, must list Subcontractors: List the cxlmpany nar,I e or Gty of Ft Collins /icy # Hectridan - Plumber Y*)03V Mledwkal i Roofer I hereby acknowledge t kit I .have read this application and state that the 4bave Wormation is comply with all requbwwft contained and dty ordinances and laws regulating lx permit is not valid until it has been d and:issued. Applicant: Print Nam Signature :d) ❑ Duplex !e ❑ Retail Hbtark Preservation electrician. ate and correct I agree to Construction. I know that a Dat p 10 J �J