HomeMy WebLinkAbout7009 Sedgwick Dr - Applications/Water Heater - 04/17/2015From:
04/17/2015 15:19 #154 P.002/002
+F&City of Planning, Development & Transportation
I Co!! ins N. College Ave P.O. Box 580
`�' a Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
❑ Heating Unit O Lawn Sprinkler O Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation %Water Heater O Water Line O 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 #_ a (Sa 3 l 3-% Date _7�/ S
I-" umice use ony
]ob Site Address (raqulnadJ Value of Construetfon labor, materials, Profit
-7(�l i �1 �,.� (�
Property Owner Name Address
sty/State LP Phone S7S
\�LSIT�1Pa` f�h2�t�y�S 7nrll4 in I�.. i� iL� �f{-/'.•.fi„�c10 ,rrf7 �¢
1lcant E�lame Address 5 YNa r`)6C
City/State 29 Phone c'f-)O,y
Contractor q-60 i
Address City/State Zip Phone �717
Contractor City of Ft Co ns Sales Tax # Are you paying taxes here or b re 't
SolerinflWnberIs/e akedbyaNmnbacarx Y report? ❑Here O Report
� r 27 Are You Paying with your trust account? Yes ❑ No
Is this a residential or oommercial project? KRes(dential ❑ Commercial
If residential, is It: GiSingle Family Detached ❑ Condo/townhome (single family attached) O Duplex
Multifamily13 l
If commercial, is it: ❑ Bank ❑ ear❑ Church ❑ Hotel Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant O Other (explain)
Is this building SO years of age or more? O Yes ®.No Ifyes, yvu mayneed to contact If this Is for a demolition permit, what year was the building constructed? Hu7nric Prt jeryaI yon
Ypnor to 1975, y0i,;W1 need an ast;estos azessmpnt to submit W1h this apAlfcati. .
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list Ucensed electrician.
Subcontractors: List the colnNny name or Gty Of Ft Co/11ns hose #
Elecbidan Pluniber-150,9-1211q. Menial
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
Permit: Is not valid until it has been paid and Issued, regulating building construction. I knew that a
Applkant.
Print Name:
Signature Date � 7
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