HomeMy WebLinkAbout6121 Carmichael St - Applications/Water Heater - 02/25/2014Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO $0524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application# P190V) Date a/afy
For ofhe use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
lal A lc & St
i 048,S/
Properly Owner Name Address
City/State Zip Phone
110t1l LZiNC' 805A8 i-7o-aaa-i35y
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
PAULa PLUMIBIfQG. v-+4rG- P0. 6oxI65[o
LuveLPrna Co ?p53 779•&&3-34 3
Contractor Cty of R. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
sales am number hrequkedby0cnftcblm
Are you paying with your trust account? XYes ❑No
Is this a residential or commercial project? OResidential ❑ Commercial a S,00 {ERrAI
If residential, is It: ,WSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage .Zv,IR CveyT I
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel L7 Medical office ❑ Office ❑ Retail 3.: s Co. T
❑ Restaurant ❑ Other (explain) y9.3` _ o
Is this building 50 years of age or more? 0 Yes O No Ifyes, you may need to contactH/storic re
Preservatron
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1974 you will need an asbestos assessment to submit with ffia applkaf %
Description of work RE PL Prc.E 5 D 6091-L.OIV 6 AS &) lk-TIM h E-Pr7 )Q
*If lawn sprinkler/baddlow preventer, must list licensed plumber, If first-time A/C, must list iicensed electrician.
Subcontractors: Llst ft onmpany name orG'ty of Rollin llcense #
Elecb1clan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above Information Is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant:
Print Name: SAr_04 Ile E r_p44 4Signature I(aa.�C Date A/2S/'/'�
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