HomeMy WebLinkAbout1601 W Swallow Rd - Applications/Water Heater - 11/05/2015From:
11/05/2015 17:05 H263 P.002/002
City of iPlannialt, Development IN Transportation
r"t281 N. College Ave P.O. Box 580
Cd 1linS Fit Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to ap
13 Demolition (inferior non-structural py for the following permits only (check all that apply). 13Air Conditioning
❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 17 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation GLWater Heater 13 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the appllcatlon. Incomplete applications will not be acrBntod
APP11cation #_ S V
rnrdrAW esr only
.lob Site
Date i S I I j
'-"
Value of Con
,n (labor, materials, per) i j-1
.ol?
Owner me Address
ty/State
I
Bo one 916
D�"1//��3
Name Addre55
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Phone o110
Co9-6
3
r Address
City/State n
ZIP P1lDne 970
Contractor City of FL G.>NAS Sales Tax #'adJ
saesw,rkv,xrris,epreteddrer m+rmaas Are You paying taxes here or by report? ❑ Here ❑ Report
Are You paying with your trust account? KYes ❑ No
Is this a residential or eommendal project? J j Residential ❑ commerdal —
If residential, is it: O Single Family Detached Of Condo/townhome (single family attached) ❑ Dupes
13 lalmllY If commercial, Is It: ❑ Bank 13 Bar p Church rch O Hotel Motel ❑ Medical ofliee ❑ Office O Retail
O Restaurant 13 Other (explain)
Is this building 5D yeanh Of ape or more? 13 Yes Ap No If yes, ynu my need to wilt ad H/stork PYespita
If this Is for a demolition permit, what year was the building Constructedp tran
tfAyorla 1975, yhw wQ//rr�an elabeslos assessrnienl to wbm/f ►Hfh lhls sgdxaCon.
Description of work
:
*If lawn sprinkler/bac#tow pre enter, must list licensed plumber. If first tlrme q/C, must list licensed ekxtrican !
Subcontractors: Listlrrecomprnyna/MorOlyofR4gftAienIf L !
purnbe'4q7 , Mechanical 1
Roofer Other. i
I hereby acknowledge that I have read this aPPNatlon and state that the above information Is complete and Corned I agree to '
comply with all requlrements contained herein and city ordinances and state laws regulating building construction. I know that a
Pumit Is not valid until It has been paid and issued.
l►POlkant:
Print blame: Slgnaturc
DaEe !