HomeMy WebLinkAbout1925 Real Ct - Applications/Water Heater - 07/28/2017planaling, DevelopIrrient & Trnnsportatic�;t
1
281 N. College Ave 1 P.D. Box 5,90
Fort Collins, CO 805214
Phone 970-416-27401 Fzzw 22-1 -o 1 -1
for the following Pei-mif
is f be USed,10 apply Ls Only (check all til
")--.,!1'oRio11 (interior FiOn-StrUM11721) 0 Electrical Alteration (not service change) 0
I !baling Unk 1-3 Lawn Sprinkler El Mobile Home replacement 0 Roofing 0 Sew
Ventilation 'Nater Heater 0 W 9ter Line 0 Wood/Pellet Stove (must be EPA 'I
i
1�!mjr:ncturer) all infor0ation on the application. Incornplete applications
Date
-7
P
For 01fice4-o only4
Value of Construct
-:.2 Ac"Ji-ess (r&�Ijfi-ad)
(J5
pj.j:j,)e.l,Ly Owner Name Address City/State
...... Address City/State
5.
Address
N L'y
,it apply), [] Al; Conditicl!''
as Lighter F-1 Gas Log
r Line 0 Phoio-voltaic
ified, provide mane. 1) vjckaj
not be accepted.
- ----- ----
(labor, mal-erid).S, 11101 H.j-
Zip hone
C'
Zip Phone
City/State zip phorl---
n
Va ace 4Vk1T I -..-ktq
s Sale7-9 Tax # Are you paying taxes here or y report? 0 Here
(j*E;.,-tol- City of Fit. Collin .1
unit? 'Yes 1-1
Are you paying with Your LI'Ll I aC00
is tills a 1-clsido-itial 01 . commercial project'? 'ClrResidentiai 0 commercial
i., it: 0 Single Family Detached -Condoftownhome (single family
0 Multifamily' (apartment) Garage Cl Medical office
.1-cial, is it: 0 Baril( El Bel 11 Chui-ch 0 Hotel/Motel
[-J restaurant 0 odier (explain)
I.Alilcliliq so yeal-s of age 8r more? El Yes 0 No IfYes, YOU May need to
dan'-o!:ttoll Pe"n"k what year was the building constructed?
assessment to submit with this apphraUon.
to .1 Y75, yOU Wil need an asbestos 3
------------
wortk�". Ft
k-a-A-+ dA
FJ LA!PleX
0 Office El Retail
-l
Ir sprinkler/bElckflow i)revent6r, must list licensed plumber. IF first-time A/C, MUSt ist
'co!j,,j conipany'name Groty cf Ftcoffins license #
Roofer
mectianical--
1-w z)jjujowlodge that I have read this application and state that the above information is
with all requirement,; contained herein and city ordinances and state laws regulating b
1jc)t jjaj1d ur,J! it ivas been pa'd and issued.
Hi5tork'Pne5,2110600
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constl'LICUOil. I JWMV
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