HomeMy WebLinkAbout709 Dearborn St - Applications/Water Heater - 09/06/20110/07/2011 11:23 19702329739
Pt Cottins.
Planning, Development & Tran
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61
OVER-THE-COUNTER PERMITS ONLY
This application is to lie used to apply for the following permits only (check all that apply). ❑ A
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 17 Gas lighter O
❑ Heating Unit ❑ Lawh Sprinkler ❑ Mobile Home replacement D Roofing 0 Sewer Line ❑ Phc
❑ Ventilation lik Water Heater ❑ Water Line 13 WoodlPeilet Stove (must be EPA certified, provide i
manufacturer).
Complete all appllcablie information �'1►on the application. Incomplete applications will not be act
Application #� o 1 l � Date
ForofAi- m only I S. CID
PAGE 01/01
Conditioning
as Log
model and
]cab SIDe Address (req�riir'dJ �� "" Value of Construction (labo
'10q �2.a� b�rv� �'t} , l,a►�S� 25 q
ials, profit)
ss City/State Zip
Property Owner Name i T.QbD,
�wv< (109 S't ��C '(,� 2)0525
Phone �j % 0
-ZA-1-- 'ftn
Applicant Name Address City/State Zip
c*-t 405'envw Av, Lorne[ U ,$D53
Phone q10-
-um- wi
Contractor Address City/State Zip
Phone 6%-
'fernin t-YI UCLA— QIambi 4S5�MW LD
'Co 8D551
Contractor City of Ft. Colllns Sales Tax. # Are you paying taxes here or by report? ❑
ere V Report
.se%starnumberisreouIiedbyai[mnvectomAre you paying with your trust account? 1�1
I'I -y1
es ❑ No
Is this a residential or Immercial project? R Residential p Commerdal
If residential, is it: Single Family Detached Q Condo/townhome (single family attached) ❑ Duplex
IMuitlfamily (apartment) ❑ Garage
If commercial, is it:, Manic 0 Bar ❑ Church 13 Hotel/Motel O Medical office O Office ❑ Retail
13:Restaurant ❑ Other (explain)
Is this building 50 year$ of age or more? O Yes O No Yyes, you may need to contact Hbiorfc PresE rvaWn
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assezment to submit with th/s applicadon.
Description of work -Yva4t-j- -�
*If lawn sprinkler/baddlOw preventer, must list licensed plumber. If first -tine A/C, must list licensed eledridan.
Subcontractors: List company name or01yofRColllnslkerlsie #
Electrician Plumber Mechanical Roofer
I
er
I hereby acknowledge that I have read this application and state that the above information is complete and
comply with all mqulrem+nts contained herein and city ordinances and state laws regulating building eonstm
Permit Is not valid until it has been paid and issued.
Print Name.. Signature _ ��_ / Date
L I agree to
I know that a
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