HomeMy WebLinkAbout1024 Mirrormere Cir - Applications/Water Heater - 03/06/2014Mar 06 14 09:13a Rues, LLC 970-619-8074 p.1
�o-'rrt CoUins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61M
OVER-THE-COUNTER PERMITS ONLY Pee It Zb."1S
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Dernolition (interior non-structural) ❑ ElectricalAlteration (not service change) ❑ Gas Lighter ❑,Gas Log
❑ Heating Unit 17 Lawn Sprinkler ❑ Mobile Hone replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 1. Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. incomplete applications will not be accepted
Application # d l L} b 1 I I Date
Forafte here only
lob Site Address C>��
Value of Construction (labor, materials, prof)
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Property Owner Name Address
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City/State Zip Phone
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Applicant Name /j Address
a.i 405- enve.v
City/State Zip Phone q')O-
Ave Love-i U 80531 LPS5-`i511
Contractor Address
CtYlState Tip Phone (#%-45
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Cnntradmcf4 oUt..0111na SalesJax #.
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Are you paying with your trust account? q Yes ❑ No
Is this a residential or commercial project? � Residential ❑ Commercial
If residential, Is it: WSingle Family Detached . ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It:. ❑ Bank ❑ Bar ❑ Church ❑ Hotc/Motd ❑ Medical offce ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No ffyes, you mayneed to cait&&Hst vkPraQwwi vn
If this is for a demolition permit, what year was the building constructed?
ffprA2r to 1975, yuu wr71 need an asbestos assesarrnent tv submit wide this app/,ccallors
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*If lawn spriMerlbacidlow preventer, must Bst licensed pkimber. If first-time NC, must list licensed electrician.
Subcontractors List the, cwwny name or cRyofFt roans li wzw ,#
Secb n Plumber Medanical RooferOdW
I hereby admowledge that I have read this application and state that the above information is cornplete and coned. I agree to
comply withal requirements contained herein and city ordinances and state laws regulating building construction. I knowtitata
permit is not valid until it hers been paid and issued.
Applicant: j�
Print Name4 0. Y i f9a � tr Signature - --
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