HomeMy WebLinkAbout4560 Larkbunting Dr - Applications/Water Heater - 07/28/2017Planning, Del/elo
g 281 N. College Ave
Fort Collins, CO 81
Phone 970-416-27A
is to be used to apply forthe following permits only (checl( all f
i ;::n;olition (interior non-structural) ❑ Electrical Alteration (not service change) El
I 1-hating Unit 11 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sew
i Vol lilation ater Heater f;7 Water Line ❑ Wood/Pellet Stove (must be EPA ce
�. �;oilli)1.'.te all a!7!%i i:.F:bie '3foroatilon o,nnttile application. IncornpletE applications
jefflice;ForXUSE?
_ob - iq-a Ad3i2ss
I' i;palrty Owner Name
1 AAouliCrIV,qr.i
ame:
ntraclor City of Ft. Collins
LA , unG;• all
Date
Value of Coo�str>act
:J Address City/State
i
1 Address City/State
Address City/State
Tax tl Are you paying taxes here or
tors. Are you paying with your tru!
Sent & "a'ransportntiui:
P.O. Box 5,1)
Fax 2")4-61".
ONLY
at apply). ❑ Air Conclitbr);;!rn;
ns Lighter CI Gas Lai
r Line CI Photo -voltaic
tified, provide make, nrxla,
t_ ti;is a ;;:si(.icntial or commercial pr'.oiect? lResidential ❑ Commercial
,'_ .Gbanrial, is it: ❑ Single Family Detached Condo/townhome (single family attacl
❑ Multifamily (apariinent) 10 Garage
ir;:,;nuuercial, is it: CJ Bank ❑;Bar ❑ Church ❑ Hotel/Motel C7 Medical office ❑ Of
❑ Restaurari ❑ Other (explain)
niildilig So years of age or more? ❑ Yes ❑ No Ifyes, you lirayneed to comic
a den:olitioil Periini , what year was the building constructed?
1.); to .1975, you Will need an asbestos assessment to submit wiM this application.
D.> cripi:ionof workJ)emo._Ve ---�✓ � i `- --'f
f I,revn sj,rinkler/hackflow preventer, must list licensed plumber. If first-time A/C, must list Iicel
sac:ora) actilrs:Ilst(hacompanynemeorCityofFtCollinslicense '
Roofer _
Plumber------ Mecrianical__ --- --a
.•:: I-m ,,.I;i)ovaledge that I have read this application and state that the above information is cs
,,!;:!IV with all requirements contaHed herein and city ordinances and state laws regulating built
valid ni7i31 it has been paid and issued.
not be acceptod.
n (labor, rnaledals, profit;
(�rr'
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—Zip
Phone
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Zip
Phone
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— _1 e
y report?
❑ Here _n.Rcnort
account?
Y-Yes ❑ No
❑ Duplex
❑ Retail
l-listo/ic f�re5'r'lVdl.'inn
electrician.
Other
ate and corr"CL. ! agreu r.:
corlstruclioii. i lu,ow'd a::
a ..
V �: U ` 7
_Ili11 C117 �� ,ignature --� —1 —ovate �1� (r /r J
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