HomeMy WebLinkAbout1508 Thimbleberry Ct - Applications/Water Heater - 10/06/2016OCT/05/2016/WED 02:35 PM FAX No, P.004
�, City of
cart Collins
ram..
Planning, Development & Transportation
281 N. College Ave P.O. Box 58o
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply), ❑ Air Conditioning
❑ demolition (interior non -structure!) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
CI Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
L7 Ventilation VWater 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 Date ID& (o ` 20
For ofl9ce use only
Is this a residential or commercial project? i'Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached 13 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) Q Garage
If commercial, is it: ❑ Bank 0 Bar ❑ Church 4 Hotel/lyotel ❑ Medical office ❑ Office C] Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes WNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit w/th this appl/cation.
Descriotion of
*If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: Ust the company name or Clty of Ft Collins llCense #
Electrician_ Plumber Mechanical 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 regulating building construction. 1 know that a
permit is not valid until it has been paid and issued.
Applicant: ace F, l,�
Print Name: ,_ Signature Date I015 i! la