HomeMy WebLinkAbout401 Dunne Dr - Applications/Water Heater - 04/24/2012Rues, LLC
970-619-8074
PA
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Planning, Deveiopment&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 tobe used to.apply for the followingpermits only (check all that apply). Q Air Conditioning
❑ Demolition (interior talon -structural) El Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ LsJvn Sprinkler ❑ Mobile Home replacement Q Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ Ventilation IK Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application # ca12O222
Foroffibe the only
Incomplete applications will not be accepted.
Date —4 Z4- . 1 Z—
Job Site Address (required_
---T � Y
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State zip •;�L�2.5 Phone
Applicant Name Address
City/State Zip Phone q10-
av+ Qcamel,- 4,05
Aue Lovt( C,,o &531 um-45`I i
Contractor Address
City/mate. Zip Phone (c%'
exl am;n C*jawjWf! - Q Wmbi ny
4SS �r CO &p55-7
Contractor City of Ft Collins, Sales Tax # 0
Are you paying taxes here or by report? . Cl Here V Report
s&estaw nunherIsreg"byaff== fam
Ao rl
Are you paying with your trust account? 1A Yes ❑ No
Is this a residential or commercial project? 1� Residential ❑ Commercial
If residential, is it Single Family Detached ❑ Condo/tgwnhom❑ e (single family attached) Duplex
1Nluii4famlly (apartment) ❑ Garage
If commercial, is It:, ❑ iBank. ❑ Bar ❑ Church ❑ Hotel/Motel ❑ medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50.years of age or more? ❑ Yes O No rfyes, you mayneed to contact I- storfcAres&ruatlon
If this is for a derriolllioe permit, what year was the building consfrucbed?
Ifprtor to 1975, you w/N need an asbestos assessment in submit with this application.
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list Ileensed electrician.
Subcontractors: Lfst M6 company name or Cly of Ft Collins license #
Bedsician Plumber Mechardcal Roofer
Other
I hereby adawwledge that I have read this application and state that the above information is complete and correct I agree to
comply with all requiremehis contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid untif it has been paid and issued.
Applicant;
Print Nam., a.Y t- s1' - ► -4' Signature Date
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