HomeMy WebLinkAbout5000 Sawhill Dr - Applications/Water Heater - 07/28/2017i
Planning, De;velopIm ent & If inns po r Na ti ui
281 N College Ave l P 0 Boy "I)
Fort Collins, CO 805?14
Phone 970-416-27401 Fa,( 22=1-611 '
s .;pjIlea ti,)r is to be used to apply for the following permits Only (checl( all tP
i n,()ilhol, (interior non-structural) ❑ Electrical Alteration (not service change) ❑
I ' I- -lung Unit 11 Lawn Sprinkle, ❑ Mobile Home replacement ❑ Roofing ❑ Se
I Ventilation ater Heatei Q Water Line ❑ Wood]Pellet Stove (must be EPA ce
iurcturei)
\ \ ,t),Iipllte all apl'l,:,abla inforoation on the appliCatlOn. Incomplete apAtlCat10n5�,
el —4
\oljllcFliion 4 __b! 0 Dated 15?
liv ofr/co use only
— Value of Construct
PI ,oel ty Owl ier Name Address City/Stale
i �Aopi1c giVIC,
n 1 Address A y City/State
/: H1 1 G L _` a �*! '�-� • � �''�
I•, ,,,Ilr,tt,O { Address City/State
-
I uriU actoi City of Ft Collins Sales Tax # Are you paying taxes here or y report? ❑Here
Are you paying with our tru I account? 'Y-Yes
,_ ,J„umiben;raymredGyallcuntiactnrs Y P Y 9 Y
-NL
it apply) LIAli COIidltlQi,
as Lighter I l Gas Lo,j
r Line CI Photo -voltaic
fled, provide make mock l
not be accaptcd
(labor, niaLenals, piciiL,
Zip Phont_
-71
ZIP / Phrn ie
i
Zip Phones
f
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.Rono1 i
f_1 I' to
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�sidunual otLllhfarnil�
il ercial project? Y 'Residential ❑ Commercial
.I ,e•vi�aulal, i5 dngle Family Detac ed ❑ Condo/townhome (single family atta(.t
(apartment) ❑ Garage
oninierclal, r, tl ❑ Bank 'Bar ❑ Church ❑ Hotel/Motel El Medical office ❑ Of
❑
❑ Restaurant ❑ Other (explain) -
1„iiiclllic! 3o years of age or mole? ❑ Yes ❑ No Ifyes, you mayneed to cant
I, rot a de.,:ouion permit, what year was the building constructed? _r
t,) t 975, y Ju fwll need an asbestos assessment to submit with th/s applrcabon
Hplloll of wort(__
Ir 1„wn +p, mkler/backnow prevenler, must list licensed plumber If first -Lime A/C, must list Ilcer
5 , co meta. s Litt tl)a cvmpany'nante or Gty of ft Collins l'cense m
Plumber— _ _ _ _ _ Med)anical__ - _— -- — Roofer--,
rrn .i kl;owletlge LhaL I have read Lhis application and stale that Lhe above information is q
n n, 11J will, all iequirements contained hetein and city ordinances and state laws regulating builj
i� spot valsr! U ul it has been pa,d and issued.
❑ Uupl e.c
FOUT41711I
f1715to11C Preselvat/nn
--
ed elecLiinar
,plete and comet I agrat, 1,
rlo construclarnl I lu;ow tht
c te ! � 1l1
>�.4 Pia)• eS, /�R1 ►C�11 `� t'L� �ignatvre rt.+ a/..W`„-- � Vva/
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