HomeMy WebLinkAbout2713 Stockbury Dr - Applications/Water Heater - 10/23/2013Oct 23 13 12:53p Rues, LLC
970-61 M074 p.1
Planning, Development &Transportation
City of 281 N. College Ave P.O. Box 580
Fit Collins Fort Collins, Co E;052-4
Phone 970-41616-2740 Fax 2246134
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 0 Gas Log
❑ Heating Unit ❑ 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.
Application # 61
For office use only
lob Site Address (required)
a--I13 �) -to &L b
Property Owner Name
Applicant Name
Contractor
T2y- . re,
Address
Address
Address
W rv\.b i r
Contractor City of Ft. Collins Sales Tax # `
Sales cox numberis required byall contractors
-4- 1 175 1
Incomplete applications will not be accepted_ �®
Date J0
Value of Construction (labor, materials, profit)
)5a5 4 ) q'7 8,
City/State Zip Phone
9'7p - 0 &;1 634e )
City/State Zip Phone TI0`
Loveio-MI.S10 80531 lntb5-+5q l
City/State Zip Phone (a%' ?
5
Are you paying taxes here or by report? D Here V Report
Are you paying with your trust account? P Yes ❑ No
Is this a residential or commercial project? M"Residential ❑ Commercial
if residential, is it : L3/Single Family Detached ❑ Condo/townhome (single family attached) ❑ duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it:. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office' ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building So years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact HistoricRreservatfon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkleriback low preventer, must list licensed plumber. Ir first-time A/C, must list liicensed electrician.
Subcontractors: List6he company name orCdyofFtCollins license #
FJevhician
Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above informabOn is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. 1 know that a
permit is not valid until it has been paid and issued.
Applicant•.� _�� pates lG of 1 N
Print Name. 0_Y t- PQ E'rYV__'AK- Signature