HomeMy WebLinkAbout4107 Mill Run Run Ct - Applications/Water Heater - 01/27/20120
City of
Fort 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 appliication is to be used to apply for the following pennft only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) a Gas Lighter ❑ Gas Log
❑ Heating unit ,❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation KWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable infomration on the application. Incomplete applications will not be accepted.
Application # DO � f Z b'A U V
fia.ONce use M*
Date 411-*14�
Sob Site Address lre7ukeo
40M-A Rk,vk CA
Value of Construction ( , materials, profit)
9 5z .Oo
Property Owner Name Address
b"ImIr VAVA Llto1 k.kPAM4
City/State Zip Phone
FoT -hs fAM515 540-x154-40
icant Naime Address
Y CAY4a CS tS'ame a&beloYv
City/State Zip Phone
Bib- 19�,-5a�3
Address City/State Zip Phone
60 0EDase-1 ne)ad.
1Zo7krM,a,,,,Az $62d, Ub9ai-5D-13
0155
M65a,
Contractor City of FL Collins Sales Tax p
Are you paying taxes here or by report? WHere ❑ Report
Sa 7&fflr3 regrwc+dbYa#cwr"rar7m
Are you paying with your trust account? Imes ❑ No
i fbb ��jj;;��
V2u 6t
Is this a residential or mmmerdal project? WResidenbai ❑ Commercial
If residential, is it: ❑ Single Family Demdhed ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hatel/Motel ❑ Medical office ❑ Office t7 Retail
❑ Restaurant ❑ Other (explain)
Isthis building 50 years of age or more? ❑ Yes o Ifyes, you may need to contact Kcstnric Preservabo n
If this is for a demolition permit, what year was building constructed?
Ifprfar to 1973, you W7/need an asbestos aswsmnent to siih77d mm this appiawbon.
Description of work
'If lawn sprinkler/badd7ow preventer, must list licensed plumber. If first-time A/C, must fist licensed electrician.
Subcontractors: List ffie company name or Gty of Co/frns rx erase #
6ecMclan Plumber Mechanical Roofer
6TV
Other
I hereby aclam dge that I have read this a Oimtion and state that the above information is complete and correct. I agree to
comply with all regdrements contained herein and city ordinances and state laws regulating budding construction. I know that a
permit is not valid uFM it has been paid and issued.
in tcard:
ftinj1.�r(1t 1T
Prt blame:_