HomeMy WebLinkAbout4119 Snow Ridge Cir - Applications/Water Heater - 08/14/201708/14/2017 12:48 FAX 9703817127 RAMS PLUMBING INC 9 001
Cit Of
oN Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application IS to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter CI Chas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Una ❑ Photo -voltaic
❑ Ventilation SMater Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # u rn 4-1 lQ Date Ot i.L-i I zon
Far &me use only
Job Site Address (naqutmd) Value of Construction (labor, materials, profit)
L4119 5mow K-10(vtr Ct2. 1$-)50
Property Owner Name
Address
City/State
Zip
Phone
Ll9A- MOMPS3rJ Ll 119 5M0,,.J %or t: Qta. I-n. COLL i r4c co
$OSL(o
C9-lo)
9seW9
Applicant Name
Address
City/State
Zip
IPhone
Contractor Uc #
Address
City/State
Zip
0-10) Phone
(�IaNka Pwmglt.56 MP#53y
P� �t7jc i
4s f~7. CO Imo, c,0
�A.Sz2
010- %9971
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here E Meport
sales r aer/Sm7u/redbyA#contracmrx
Are you paying with your trust account?
aYes 17 No
y
Is this a residential or commercial project? PrResidential 0 Commercial
If residential, Is it. 63,5ingle Family Detached 13 Condo/townhome (single family attached) 0 Duplex
0 Muhlfamlly (apartment) ❑ Garage
If commercial, Is It: Ip Bank ❑ Bar 0 Church 0 Hotel/Motel 0 Medical office ❑ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building Bo years of age or more? Dyes 0740 Ifye4 you may need to contact HIstnNC Preservadon
If this Is for a demolition permit, what year was the building constructed?
rfPMr to 1975, you w/// need an asbestos assessment to submit with th/s app/kabron.
Description of work 2 = L40 64LW r' C4:> (37 t.4i:W7
*If lawn sprinkler/bacldiow preventer, must list Ilcensed plumber. If first-time A/C, must list licensed electrician.
Subcontractorsr List the company name or city offs Cb/Nos 11ceme g
Electdclan Plumber Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above Information Is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit Is not valid until It has been paid and Issued,
Applicant: n Oly �� MQ 11
Qi _1 . QM
Print Name• /--1 !J �CrJ Signature l�lt�lA G'Vl / f !Q dk►�� Date U