HomeMy WebLinkAbout4603 Chokecherry Trl - Applications/Water Heater - 10/23/2013Oct 23 13 12:53p Rues, LLC
970-619-8074 p.2
FortCollins
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 application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas. Lighter ❑ Gas Log
❑ Heating UnK ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ 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. In applications will not 6e accepted.
CPS
Application # v' Date ---
11 For office use only
lob Site Address (required) Value of Construction (labor, materials, profit)
rL` raa l tea- �'.CGSa ro 19a
Properly owner Name A dress City/State Zip Phone
M ry, DYA-S tury -
Applirant Name Address City/State Zip Phone 14'
fir. r r (�afrnei- 455 - enw-r 80551 US5-461 I
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # 0 Are you paying taxes here or by report? ❑Here Report
sales tax numberisrequired byail comracions Are you paying with your trust account? � Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: UrSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it, . ❑ Bank ❑ Bar ❑ Church 13 Hotel/Motel Q Medical office ❑ office ❑ Retail
Ci Restaurant ❑ Cther (explain)
Is this building 50 years of age or more? 13 Yes ❑ No if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wfffneed an asbestos assessment to srbmil- with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the mrnpany name or OfyofR Collins license #
Electrician ?lumber Mechanicai 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. t know that a
permit is not valid until it has been paid and issued.
Applicant:
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1 ry
Print Name�� Y � PPL� IAS A-- Signature - - sate