HomeMy WebLinkAbout2006 Lindsey Ct - Applications/Water Heater - 04/08/201404-09-14;08:07AM;
;970-484-4448 # 2/ 11
of
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
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 D Lawn Sprinkler O Mobile Home replacement ❑ Roofing 17 Sewer Line C7 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 # T-) 77-0 l Date
ForolncB use only
7 b Site Address (rr°qulred)
Value of Construction (labor, materials, profR)
V059
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Pro rty Ow er a e dress
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city/State Zip Phone
•a 303=8�0- 5�
Applicant Nam Address
'A1 / . Q U
city/State Zip Phone
I05 q74• 8yl
k tractorAddress
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City/State Zip Phone
, Pa SoSa yYy t l
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by repoit?.CL Here Pkeport
Saes raxnumber lsp010 bya//ccnaadam
Are you paying with.your trust account? Yes ❑ No
Is this a residential ory� merdai pro)ect? Residential O Commercial
If residential, is it: ingle Family Detached D Condo/townhome (single family attached) O Duplex
�j MultifamAy (apartment) O Garage
If commercial, is it: ❑ Bank 0 Bar ❑ Church ❑ Hotel/Motel 0 Medical offioe ❑ office ❑ Retail
❑ Restaurant O Other (explain)
Is this building 50 years of age or more? O Yes O No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
Yprfor to 1975, you W11 need an asbestos amessment to submitWth this appllcadon.
of work
*If lawn sprinkler/baddtow, preventer, must fist licensed plumber. If first-t14A/C, must list licensed electdclan.
Subcontractors: list the company name or aty of Fe Collins li=se #
Mectrrdan Plumber L Mechanical Roofer I Other
I hereby acknowledge that I have read this application and state that the above Information Is complete and mrrecL 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, rCxdtyth
Data `7 4 q