HomeMy WebLinkAbout5224 Abbey Rd - Applications/Water Heater - 11/24/2014From:
11/24/2014 11:03 0094 P.002/002
Fort Collins
Planning, Development & 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 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 ❑ 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. Incomplete applications will not be accepted.
Application # :9 144 2LS 12 Date / / - 2 q - i z{
For e>>Pce use only
Sob Site Address (requved)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
aNAti UP�i-70'-
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Applicant Name-Ji�,wC c%L-t>Ck[
Address
City/State Zip Phone
J• 14F(-�
201
rz.Sr petit t.cdc:an_,� ccbC S% `r-7o fot�1-i<C75
Contractor
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Saks taxn!r,,asreguiredbyalimnoaabrs:
yl-�1
Are you paying with your trust account? )KYeS ❑ No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: aSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank O Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ANo 1fM5, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work rP n la CrV�rc e.r heel �Y'
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or cdy of R Collins license #
Electrician Plumber KAP - 3 L-4* Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above informadon is complete and correct. I agree to'
comply with all requirements contained herein and city ordinances and state laws reguladng building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: 1 /
Print Name: --J AKIC- C? 1_ ,So tv Signature(-� 4� )2'l
� Date —+ i - Z-4. - 1 t(.
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