HomeMy WebLinkAbout5529 S Timberline Rd - Applications/Water Heater - 12/08/2015Planning, Developnient & Transpertation
281 PI. College Ave P.O. Box 580
Fort Collins, CO 80524
Dhon,= 97C- 116-2740 Fax 224-613==
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application is to be used to apply for the follo`,ving permits only (check all that apply). ❑ Air Con•.:jition!r:g
I' I r t.1:1loiition (interior non-str!ch ball ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Loy
i31-1e ting Unit ❑ Lawn Sprilll:l-r ❑ Mobile Home replacement ❑ Rooting ❑ Sevier Line ❑ Photo-voltai,;
4.'a;tiii:at.ir)n '• via er Heater G Water Line ❑ Wood/Pellet Stove (Trust be EPA ceiiiried, provide make. n,alel -wid
Colilplo Lc- nil applicable inforinatior, on the application. Incomplete applications will not be accepted.
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Date—
cbrctr-ce use on4v
+`;;;:ir:ssiite9; Value(yof Constt^rruction (labor,
materials, proj'H')
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( Pon, o.,-- Owner Name
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Adr'r.ss Cibj/State Zip
Ad VOCCI.C,�( -
Phone
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Address City/State Zip
Phone
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Address City/State Ziprd
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!r CoiY:!'ar-tor City of Ft. Collins Sales Tax I-'
Are you paying taxes here or by report?
❑ Here. 1.Repor::
ar/contrac;ur;.
Are you paying with your trust account?
'tl;!es C. Pip
is t!lis a residential or commercial project? ❑ Residential *on,lrlercial
if r �s;clen ia!, is it: ❑ Single Fancily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage.
_r commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office XDffice ❑ Rctail
i ❑ Restaurant ❑ Other (explain)—
r;- clil_ building 50 years of age or more? ❑ Yes L1 No Ir yes, you rnayneed to contactHistoric Preseruad.on
I this !s for a demolition pern,it, what year was the building constructed? __—
!i /.Y 7 _19.'5. l'Oe' : #l^7eod an asboiios assessment to submit with this vpp&ation.
D sciiption of v^rork'- e iQlzQ— 7�=(l won Xy
"`If lawn sprin . Ybac::fior: preventer, must list licensed plumber. If first -tide A/C, musC listlicensed electrician.
S!rbcontracfrrs: Lrstt/:ecornpznynameor0yofF 611inslicense r
Mechanical Roofer
I her.2by adc:.ov'rlodge that I have read this application and state that the above information is complete and correrl:. I agre:: to
a,mpy' with all requiremencs contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
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