HomeMy WebLinkAbout5851 Dripping Rock Ln - Applications/Water Heater - 06/30/2017 (2)i
Planning, Developnnent &-J'ransportatio,:
281 N. College Ave i P.O. Box 530
Fort Collins, CO 505714
Phone 970-416-2740 Fax 224 •n! .i I
I
DYER-THE-C NTER PERMITS
,,!.is :hpplicatioil is to be used10 apply for the following permits only (check ail t.
i xilitioil (interior non-structural) ❑ Electrical Alteration (not service change) El
i-hating Unit D Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sew
i Ventilation ater Heater El Water Line ❑ Wood/Pellet Stove (must be EPA ce
u:racturer)�
,on;plete all ai�plicab�ia in�fomp Lion on the�(pp cation. Incomplete applications
Date —Q
For office use only
2bu Sate Add. ass frd 11-edl 1laizse of construct
inn ?0 5:
Propoi,ty Owner Name Address
City/State
Auulicsinr Plarilen Address~~— City/State
Address City/State
i j)ntractor City of Ft. Collins
. . , - r.,; ,urnrf+ert; rw7u���� �br•al/
ONLY
it apply). Cl Air Conilitiorn r.,
as Lighter Cl Gas Loll
r Line ❑ Photo -voltaic,
ified, provide make. J11Q&31 .,..:
11 not be acceptod.
i (labor, majrterials, profit)
Zip/ pphof
Zip Phone
i
Zip Phone
Tax # Are you paying taxes here or y report? ElHere It!�Roport
tors, Are you paying with your t account? -7-yes ❑ f•I:,
is ti)u a ; sidential or col "dal project? OrResidentiai ❑ Commercial
re uiential, is it: Ingle Family Detached ❑ Condo/townhome (single family att
❑ Multiramili/ (apartment) ❑ Garage
!i c:nnunercial, is it: ❑ Bank [];Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑
❑ ResLauranl: ❑ Other (explain)
1:; . Imilding So years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to can
ri it c 1s for a da:hhoNtion permit, what year was the building constructed?
, a a ,r t,) 1975, ybu wiil need an asbestos assessment to submit with this aPPllcation.
i?escripi:ion of work
If letwn ,prinkler/bad(fow preventer, must- list 1(censea plumber, If first-time A/C, must list 11
5:;;:.:ont actors: li.st the cvmpany name cr Qty of Ft Collins license
Plumber __ Mechanical.—__ Roofer -
IhV acrwowlcxige that I have read this application and state that the above information is
,;,;,ly with all requirements contained herein and city ordinances and state laws regulating bi
onit is rot valid unfit it has been paid and issued.
shed' ) ❑ uuplex
I
Ifice ❑ Retail
I
Ir Histonc Praservalmn
r•
in' sed electrician.
Oilier
omplete and correcL. l agree r,:
dlnq construction. I know that i.
0
Na:::c�, _ �rM /LWI'l� signature __ cw. _ 1/�V•, ' 1!aOvate