HomeMy WebLinkAbout727 Roma Valley Dr - Applications/Water Heater - 06/28/2017Planning, Development &'Tl'ansportndc,�
281 N. College Ave P.O. Box fist:
Fort Collins, CO 80524
Phone970-416-2740 Fax22.,1-5131
VE -THE,-001 TER PERNIF ONLY
i":a pplicadoo is to be used to apply for the following permits only (check all that apply). El Ai; Conditicrc
_i f_ o- iolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter F 1 Gas Lori
I I-I?.ding Unit D Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Phoio-voltaic,
i Vantilatlon ater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make. in idai
; itachi ii8CtU1"Br)
Gomplate all applicable information on the application. Incomplete aPPllcatioonts�wiilI not be acc2ptod
? ulic_Ition ," _ 1 --- Date
7 - For OMOO use on/y
00 �i*s Address (rapilmd)
pi-ope!ty Owner Name
Nn
n n ricCory�. Address
Value of Construction (labor, r,:ateeriiaais,,�rpro)Ro
City/State Zlp phone
Cj_9 Z. -b
Clty/Sttaate Zip`,
City/State Zip
Phon
ia�uUaUor City of Ft. Collins Sales lax Ik Are you paying taxes here or by report? ❑ Here-dReport
rj%,nmib.risrVuiredbvall contractors. Are you paying with your trust account? f Yes =! No
Is uiis a Iasiduluai or commercial project? CITMIsidential ❑ Commercial
r ,i,.lential, is it: ff gle family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
!r cnuuuerdal, is it: ❑Bank ❑.Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurarit ❑ Other (explain)
u; kidding So years of age or more? ❑ Yes ❑ No Ifyes, youmayneed to cnntaeth/lstorlcPr�swvatr%n
a,r a deruo"Mon permit what year was the building constructed?
',,or to 1.975, you Fviil need an asbestos assessment to submit Wffi thls appllIcado�n. � n
I)•_ uiption of work Q -
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If lemn -iprinkler/backflow preventer, must list licensed plumber. If first-time A/C, muse t,A licensed electridan.
S:.;xont,actors: Lb;tthe company name orCity ofRCollins l/cense
plumber------ Mechaniml------- Roofer_—...---- OUicl .__.
tw arkrowleuye that I have read this application and state that the above information Is complete and corlL-_L I agra. r,:
wlrh all requirements contained herein and dty ordinances and state laws regulating building conslructirm. I know t)hac t;
,: _rr-: 'sc is not valid unul it has been paid and issued.
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