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HomeMy WebLinkAbout1919 Leicester Way - Applications/Water Heater - 02/08/201202/09/2012 .10:32 9702329739 PAGE 01/01 F� ` t ' S planning, Development &Transportation 281 N. College Ave P.O. Box 580 Port Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THSCOUNTER PERNUTS ONLY This application Is to�be used to.apply for the following:permlts only (check all that apply). ❑ Air Conditioning ❑ Demolidon (interlornonsbucturai) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinider O Mobile Home replacement ❑, Roofing ❑ Sewer Line ❑ Photo -voltaic O Ventilation ktWatet Heater U Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and manufacturer) - Complete all applicable Infgrmation on the application. Incomplete applications will not be accepted. Application * U °CQ u Date 2 ' S ! 2- Foroflke use only Sob Site Address (regqu/rrd) \VV Value of Construction (labor, mter—,, profit) fit. C;o �1,'74 d US tiS o52S� I- P;gperty Owner Name; ddress city/State Zip Phone q 7 O' (Jc�Jlt t e1vl�,�se�: lq 19 1�u:tces W FC C.a Applicant Name Address City/State Zip Phone q10' av+ Cum e r 4ar. -bp-nw-ir AvL Lovc(aetL Co zo5n um- q5i i Contractor Address Gty/State. Zip Phone (A-45 ' QxA ll o F•�1�dn W A-- 0 l rvW i ny4$ 5. veneer LLWAO±A co 6 01531 Contractor City of Ft. Collins Sales Tax # 0 Are you paying taxes here or by report? • © Here $d Report sales&xnumber BregrAi #y8//whrrac&vs Are you paying with your trust account? 1A Yes ❑ No Is this a residential or commercial project? 1,9 Residential ❑ Commercial If residential, is It: %Single ramify Detached Condo/townhdme (single family attached) ❑ Duplex [❑ !Multifamily (apartment) ❑ Garage If commercial, Is R;, 0 Oank. 17 Bar ❑ Church ❑ Hobe!/Motel O Medirel office 0 Office ❑ Retail O Restaurant ❑ Other (e)Tlain) Is this building 50.years of age or more? ❑ Yes O No lfyes, you maynead to tontactHls[ar/FP rvabon If this is for a derriolid6lf permit, what year was the building constructed? Ifprior In 1975 you AM geed 2n asbestos assV.Wment to submit wnh tbisappiicabon. Description of work *If lawn sprinkler/bac M*. preventer, must I& licensed plumber. If first-time A/C, must list licensed electrician, Subcontractors: LASfy1�cw7panynameorGlyofRlbl/lnsiicenm 0 Plumber Mechanical Roofer . Other I hereby acknowledge that.I have read this application and state that the above Information Is complete and corned. I agree to comply withall requiremeirts 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 Nome s-r Q ✓ Signature bate 11