HomeMy WebLinkAbout4349 Shadowbrooke Ct - Applications/Water Heater - 10/28/20160CT/27/2016/1'HU 01:16 PM
PAX No, P. 002
Flirt GaWns
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 0 Photo -voltaic
❑ ventilation VoWater 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 # Thj(DUD40- Date
For off/ce use only / --
Is this a residential or commercial project? Iff Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerdal, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes ErNo lfYes, you mayneed to contactHistorlc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work m 150 B _
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: ust the company name or City ofFt Collins license .0
FJech idan 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, I know that a
permit Is not valid until it has been paid and issued.
Applicant: {
Print Name: , ty�F ►Afl( Signature4"14&Date 1a 27 Irp