HomeMy WebLinkAbout1916 Sequoia St - Applications/Water Heater - 05/11/2017Planning, Deveiopiment & i innsjortntio
281 N College Ave P 0 Bo.. ')4 I
Fort Collins, CO 5052,4
-= Phone 970-416-2740 Far 714 o I i
s . njlicasio,' is be used to apply for thafollowing permits only {check all that apply) L I An Cuiidjw, r '
,,:ouaon (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lightar 11 Gas L,)-,
I -wriq Unit I�� ��i�� Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing G Sewet Line C! Photo-vr�lhof,
✓anhlariuu�aler Heatei ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provrw nlwl,, III ,LI .i I ,
'.0 ).rture_,)
011;,11; Lo ail api;lwabla Information on the application. Incomplete applications w I not bt' ncc;;.pt: d
1� itlon „ Date (•;-/------
1=ur al'lcc use only --^— - .
J_•, i ,i 3 t ilar?55 (Irr]!!/r2d) Value of Go nstruction (13bOr, 11101. 1101%, i41.11,
f? —
)r,lv Ownei Noon Address C!Ly/State ZIP I,nnr
Ai)LI ,I, e.. Address 7
1P
i,101- A Address Gty/State Zip
,il.rlr'ctol Cityof Ft Collins Sales Tax // Are you paying taxes here orgy rcpori? U ller� 1 tPcpor
Are you paying with our Lrusk accounl7 iy-Yes C! rl i
r+pr,v�9ryure/J�/�, all tunhBcrars Y p Y g Y
;- j,a,., i,•sirlonu.11 ul co meicial project? esidential ❑ Commercial
single Family Detached ❑ Condo/1Awnhome (single family attached) ❑ Dur%-.
CI Multifamily (aparb-nent) ❑ Garage
„,n,u�laal, i, IL CJ Bank El Bar El Church ❑ Hotel/Motel ❑Medical office ❑Office Cl Retail
III Restaurant ❑ CiLher (explain) —__—_ —. - ---- r------
1 �Illltili ii) 50 years of age or more7 ❑ Yes ❑ No Ifyes, you may need to cont6(t Plistonr. Pa'Sr+/+1a//roll
.,;rill a de,ro!ition permit, what year was the building constructed? _;_ _ —
I,) I o; 5, y,)u wnl need an asbestos assessment to submit W/M this application
i'L,ifort (if wolk
i,••,viI pinikier/h,icknow preventer, must list licensed plumber
IF first-time A/C, must list licensed electrician
_ o' rctoIs, lt4tthecvnipanyname orC7tyofFtColl/nelicRnse
Plumber.— Memanicat— _ - _ _ —_ — Roofer _ _ _ Odi.•:
I v Ji hiiovvloilga that I have read this application and state that the above information is complete and correct I zigre,-
i;'N wish all requirements contained herein and city ordinances and stale laws regulating budding conslrur_0ru
_, i Y. I:, VOL valid LI']ui it has been paid and issued.
"'n lu ct� lignature. -- t'S' a/.y�^,e_—.� .__) _ Val-e '(l, I17