HomeMy WebLinkAbout2026 Outrigger Way - Applications/Water Heater - 06/15/2017r.- c
&7
281 N. Ctileje Ave P.O. Sm 580
.Fort Collins, CO 80524
Phone 970-416-274D Fax 224-6134
This application is to be used to apply for the iollotromg pen nis only (cheat all that apply). a Air Conditioning
0 Demolition (rderfor non-6huctund) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
0 Heating UfF,,D Lavin Spruilder 0 Mobile Home replacement 0 Roofing 0 Sewer Line ❑ PhoWvoltnic
❑ Ventilation Uifaier Heater ❑ Water line 0 Wood/Pellet Stave (must be EPA certified, provide make, model and
manufacbBe .
Compheft all apple miarrnafim on ilne won. Inconvielae applications will not be aid.
ApOitftiM * I q n 3231 Date
For t> rice we cnty
Sob 5rke AddMBS (
Value of Cbristnacdon (Mw, materlak Proflo
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Property owner Name Address
✓r Cc�� ,'s as Duirl
City/State o1 fi nSzlP
e� lti Co YM;4
Phone -15 -63
9l329y
Applicant Name ( Address
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/Cr�ity/Slate/ (� ��(� ZIP { � +�
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Address--
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City/State ZIP
Phone
Contractor City of Ft. Collins sales Tax
sates tax nuwbw is reqLdrad by all aor&zchom
Are you paying taxes here or by report? 0 Here
Are you paying with your trust acoount7 ❑ Yes
Q Report
❑ No
Is this a r rtial or project? 0 Ptes�rtiat 0 Conuner®I
If residential, Is it _ Single t°amIIy Detached ❑ (ondo/townhome (single family afladied) 0 Duplex
❑ MuNamiily (apartment) 0 Garage
if commit, is i< ❑ Bank ❑ Bar 0 Church E3 Hotel/Motel 0 Medical office ❑ Office 0 Retail
II Resrawmit 0 Odw (a plain)
Is this burg So years oyage ormore? 0 Yes ❑ No Ir-yes, ymi may need W contact Histioric Preservatian
If Uric is for a denwiltion perauit, whet year was the budding oonstrum%P
If prior to 1975, you wiU need an asbestos assessment to submit with this application.
70 IMI a'
*If lawn Spr nkW/baddlow prevatw, must Ust Uoensed plumber if ttrsMne A/C, must list Uumsed etertr'tdan.
subcorr>zwww- List the company name or City of R CalUes Howse # .
Ebcftbn-Pkmib • MedmrdW Roofer Other
I tia " that I have mead this applkatico and state that the above irllormatfan is cmnplete and correct I agree to
comply with all requirements dried herein and city ordinanms and slate laws regula&tg bull ft aort;tructiom I ieiow that a
p ermr't is rtotvalid unkI it teas been paid and Umued.
Applicant
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