HomeMy WebLinkAbout3029 Ross Dr - Applications/Water Heater - 02/12/2014a Planning, Development & Transportation
aty.a 281 N. College Ave P,0. 8cx 580
Port Collins, CO 8052.4
Phone 920-416-2240 Fax 224-61.34
OVER-THE-COUNTER PEITS ONLY
This application Is to be used to apply for the following permits only (cheek all that apply), ❑ Air Conditioning
ElDemolition (interior non-structural) ❑ Electrical Alteration (not service change) 10 Gas Lighter ❑ Gas Log
01 Heating UiA ❑ Lawn Sprinkler ❑ Mobile Horne replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
Ventilation: Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide matte, rnpdel and
manufacturer).
Complete all applicable informationonthe application. incomplete applications will not be accepted.
AppEi -at€on ,# �� 1 ----- Bate
Fir office rise only -
Job Site Address ✓kvia.red) Value of Construction ilabor, materials, proitt)
C . s �. t Ejq -;L;sI
Prope1ol Owner Name Address City State Zip Phone E� 7G3
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Applicant Nkm• Address Zip Phone
Address
Contractor City of Ft. Co€ilns Sales:T-Ax #
.lrs liar nur»ber is rzqurred dpa:! cron.�rar-•r;-:r�.
CitylS ate Zip Phone � cd'ii'
. �i['..7'� �F�� et : �3�. a. i.>ii 1 M1 � k � 7 \..-�^' J: `.il��. J� f �.;':`✓<�
Are you paying taxes here or by repoit? Here ❑ Report
Are you payinig with your trust account? Yes ❑ No
is this a residential or commercial project? Z Residential ❑ Commercial
If residential, is it: a!§ingle Family Detached ❑ Condo itownhome (single farm€y attached) 0 Duplex
v❑ Multifamily (apaltirrent) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Vedical:ofrnce ❑ Off -ice ❑ Retail
❑ Restaurant ❑ Other (explain) --------•---........-•-•- ___--
Fs this building5® ears of age or more? ❑ Yes ❑ No If e Vol/ ma'r ,mac t - • - -
y r3 y , d to c�vr<ac. Ilrstoric Pr -so
If this is for a demolition permit:, what year was the building constructed?
------------------
If prior to 19 5, )lou w,•";i near! ah ashesfos assessmart to submit ivith this .9pphration,
Description of work
*If lawn sprinkler/backflow preventer, must list kensed plumber. if first-time A/C, must ;ist licensed electrician.
Subcontractors: /-i'st the cornparg r„3mrt or City of Ft Coi,'ips %icenv #
l i• ' „) Electric:ar.----------- --P,umtw_;�_�-T'�L� t4ecfiancw:--------__- Roo;er-----.----. Other
- - —_--- ---- --------- .._... - ---
I hereby acknowiedge that I have read this application and stare that the above information is conVete and correct. I agree to
comply with all requirements contained herein and city Ordinances and state laws;cgulating buifcl ng construction. P kno"w that a
permit is not valid until it has been paid and issued.
Applicant:
Print_ Nam
Date
T do T a6ed 1SW 1SW Wd St+:b£:£0 bTOZ qaH £T n4l 8tr£8-£85 C£00 woij