HomeMy WebLinkAbout1836 Antero Ct - Applications/Water Heater - 11/08/2011Cit of Planning, Development & Transportation
F6y} 281 N. College Ave P.O. Box 580
�.t Collins� 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). ❑ Ail Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ,❑ lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation PkWater 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 #.
forOMM use aruy
Date it if L's ///
Job SIW Add (req Med)
'Se___Ayhrb
a.
Value Construction (labor, materials, profit)
ao
Property Owner Name
Fin WI �T►An 4
Address
Mbk e
Clty/State Zip Phone
U. ForfUhhS.CD 10528 97V - g11-(4
A [i nt Nye
Y lokl'G .CS
Address
0%lVaSbel0V_4
City/State Zip Phone
8&-(09A-5a-]3
CPO,
S� E d S 1111v Rd. City/State Zip Phone
$5206 %&b9A-5a--73
t I
46155
660,.4Z
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? ere ❑ Report
b Jb rehr ~byahrcannacftm
15.3
Are you paying with your trust account? F>�les D No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/bovmhome (single family atWched) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Churcth ❑ Hotel/Motel ❑ Medial office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this budding 50 years of age or more? ❑ Yes )lo Ifyes, you nuyix d to mnbd ffmn 'c Pmssw&m
If this is for a denwlhion permit, what year was building constructed?
Ypnor to 1975, you wWl need an asbestos ass 2wwrrt iv svbrrni with this application.
Description of work
*If lawn sprinMer/backflow preventer, must list licensed plumber. If first-Ume Aft , must lst loaned electrfdan.
Subcontrac or L List ft c npanymww or try of CoA hs Awwf
Bettri®n Plumber Mechanical Roofs Other
I hereby acknowledge that I have read this application and state that the above information is complete and correcL I agree to
Comply with all requbeanents contained herein and city ordinances and state laws regulating buirdirg construction. I know that a
permit is not valid until It has been paid and issued.
Applicant � (�� �
Print Nam'_:!�'`k yl'gnature �J b
23