HomeMy WebLinkAbout5342 Corbett Dr - Applications/Water Heater - 03/02/201203/08/2012 11:15 9702329739
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Planning, Development & Transportation
281 N. CoNege Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS. ONLY
This application Is tolbe used to. apply for the following.permits only (check all that apply). Cl Air Condffloning
O Oeniolltion (Interior be
❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 171 Lawn Sprinlder O Mobile Home replacement O Roofing O Sewer Line ❑ Photo -voltaic
O Ventilation %Water Heater ❑ Water Llne ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufapbrrer).
Complete all applicable information
on the application. Incomplete applications will not be accepted.
Application #y`I� O t I� 7 Date J ' 7— 1 2-
Foraffm im only
Job Site Address (required)
5 5 Q Z 0YbA:t+
Value of Construction (labor, materials, profit)
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Property Owner Name: Address
I\An o v hz �
city,/State
C,0rh -4* —or I
Zip
Cc- CA
pl) 57E5 Phone -110 .
U59- 31
Applicant Arne Address dty/State
avt
Zip
Co
Phone 4 10r
80531 UZ5-4511
Contractor Address
t3ty/5iate.
Zip
Phone (o%'
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Contractor City of FL Collins. Sales Tax # 0
Are you paying taxes here or r U p eport .
by art? I7 Here
Swdwtax a mbar&- ueedb a#mnbadors
A�n •�,� �+4 y
Are you
y paying with your trust amount? 13 Yes ❑ No
Is this a residential or� o)mmerdal project? �kesidenbal ❑ Commercial
If residential, is it: ®Single Family DetacKed ❑ Condo/townhome (single family attached) ❑ Duplex
E MuMmily (apartment) ❑ Garage
If commercial, is it;. O dank. 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office O Retail
C] jtestaurant O Other (explain)
Is this building 50 yearn of age or more? O Yes O No kf`'yex, you maypeed to conbd-H/sfmt RM-;WWb'on
If this is for a denioFitige permit, what year was the building constricted?
kYpnor to 1975, you will need an asbestos assas entto submit with Jh1sapplication.
Description of work
*If lawn sprinkler/baddiow, poevenber, must list licensed plumber. :If first-time A/C, must list licensed elix2riaan.
Suboo ntractors:.LnT6*in mpanynameorG1yofRCollins-h eim 0
Egecbioan� Plumber Mahanical Roofer Other
I hereby acknowledge bat I have read this application and state that the above information is complete and correct i agree to
comply withall rwylvemeiKs contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid urrdtit has been paid and Issued.
Applicant. n
Pdnt:Name LL.V'r Q E rv� Signature Gabe '
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