HomeMy WebLinkAbout407 Idalia Dr - Applications/Water Heater - 04/29/2014Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
F,` rt Collins 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 (hot service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Peilet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # I q o21 53 Date q&7/q
For ofte r ae only
lob Site Address (required)
Value of Construction (labor, materials, profit).
L{o-7 1DALIR DRIVE
/ a 33.90
Property Owner Name Address
City/State Zip Phone
RoaERT lAcLEfYh! 1E07 TD4414
PR. FF&uots Cn 8vsas
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
PA V �s P�vmerrv6 v H7'6, Po (3o5c ISS/o Lo(leA.AivD CO 80539 9�0��3 35f93
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?,rHere ❑ Report
Saks &rnumbarhrequ/rrdbysAcnnb
Fifes ❑ No
Are you paying with your trust account?
Is this a residential or commercial project? OrResidenfial ❑ Commercial
If residential, is It: 0Stngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Sank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes I7 No If yes, you may need to contact #dock Preservation
If this Is for a demolition permit, what year was the building constructed?
Lfprlar to 1975, you wUI need an asbestos assessment to submit wlth this apphb0hra
Desaiption of work i m sTFi`t-i- SO G A t-L oAl 6.46 WO" -Er,?- HEA TEA,
*If lawn sprinkler/baddlow preventsr, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: UstMrecompany name o atyofftColllnsflwue0
Mectidan 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: SA t- !�/ K(S S fI-49A-GEF Signature
Date Y/7.9' //q