HomeMy WebLinkAbout4208 Mesaview Ct - Applications/Water Heater - 03/29/2012I -
Planning, Development & Ttansportatiorl
r�,ity}Of 281 N. College Ave PIO. Box 580
!'6f t C.0`4S- ] Fortcoilins; 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). 0 Air Conditioning
❑ Demolition (interior non-structural)" 0 Electrical Alteration (not service change) .❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑•Sewer Line ❑ 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 # Date _
For,offlce use only
Job Site Address (requlred)
Value of Construction (labor, materials, profit) .
42o9, me -CA Vl'-w
Pro rty Owner Name
Pr
Address
City/State C.o Zip 'aI'2� Phone
Svr A --
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Applicant Name
Address
City/State Zip Phone
Contractor
Address
City/State ` Zip Phone
(.o eptt Evwar
1r O.�o
.�ev�� �. .8cq , 1. 3-99y_357
Contractor City of Ft. Collins ales Tax #
Are you paying taxes here or by report? ❑ HeFe ❑ Report
❑ No
sales tar number is required byai%mnbactoa..
Are you paying with your trust account?. ❑ Yes
Is this a residential or commercial project? EYRpsidential ❑ Commercial
If residential, is it: 1241ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑-Garage
If commercial, is it: ❑ Bank ❑ Bar Q`Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑Retail
❑. Restaurant ❑ Other (explain)
Is this building 50 yearsbf age or more? ❑Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition, permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit Wth th/s.appllcabron.
Description of work
I
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
1.
Subcontractors: List the company name or City of ft Collins license #
EleNidah_ Plumber MechaniwlIf-
More I 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: 2-1 L
Print Name: Ipr Signature (/ Date '6'