HomeMy WebLinkAbout3031 Appaloosa Ct - Applications/Water Heater - 06/26/2017a
Planning, Devalop�nant &Transportatioii
281 N. College Ave II .P.O Box 59n
Fort Collins, CO 805�4
Phone 970-416-27 Fax 27_a 6111
OVEWTHE-CUU'1411TER PERMITS
I % s application is to be used to apply forthe following permits only (check all i
_: iioniotition (Interior non-structural) O Bectrici I Alteration (not service change) 17
I Hanting Unit U Lawn Sprinkler ❑ Mobile Hotlne replacement 0 Roofing ❑ Sev
i Ventilation ater Heater CI Water Line d Wood/Pellet Stove (must be EPA cc
„IjiIuracturei) N
olnt�late all applicable information on the ap�llcation. incomplete appllcations
ONLY
at apply). 0 Air Conddior,irn,
las Lighter I 1 Gas Log
it Line ❑ Photo -voltaic
"ed, provide make nicidil
V\Ppllcatioll 44 110 _ I �O — Date
For o ca use onli
-- Val u of congtMict lon
� ou Site Add r (r�julredl
PI•cOrty Owner Na jt Address + �`//St@t
Q iY1Q �__..J! •t� �i1A I A'- pty/state
I Auulicxint ame. Address(
rlA -
ninador Address City/State
ew
it k.a]ntt actor City of Ft. Collins Sales Tax # Are you paying taxes here or
IJ%,iambPrraO'Nulred®rall can ctors Are you paying with your truss
Ls tliis •a iesidantlai or commeraal project? Tp idenhal CI Commerdal
i e u 1e1111al, Is It* Single Famd ily Detac Condo/townhome (single family atta
tMulbfam0 (apartment) Garage
itcnuullerdal, is It. ❑Bank ❑!Bar ❑Church rl Hotel/Motel ❑ Medical office ❑ t
ElRestaurank ElOther (explain) — —
in . I n ilding 50 years of age dr more? ❑ Yes , ❑ No Ifye4 you mayneed to tong
cted?
is nor a den�oNtion permti, what year was 1;he building constru
vrnr to 1975, You will need an asbestos assessment to submit wide itrls app/I®don
171•Q.,triprion of work �--�
if inwn ti1)rinkier/hacknow prevenb�r, must list
5.,,3cont sctors• LAt the mmpanyiname or G
I_+vium_ - • -- —. Plumber
not be accaptod
7Jp
7Jp
5A
ZIP
materials, proiit,
3670 -
- -- Phone
Phone
Phone
y report? ❑ Here TFJ,,Repot t
account? Pes U No
❑ Uuplax
❑ Retail
orlk Preservahmn
electridan
--- ou,et
•-,v .oc:knowlaclye that I have read this application and state that the above information Is complete and wrrecL~I agree t;
Wilily with all requirements contairied herein and dty ordinances and slate fawn regulating building conslructioii I Ienow that c.
�n tit is not valid until it has been paid and iss(ted.
j o
�rinr Nar: _/!n1 "'ir IUVA�D tgnature _ "_�1+• � _l _ vate
r. _
plumber. If first-time A/C, must list
ollIns license #
Medlanlml-----._ Roofer