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HomeMy WebLinkAbout1309 Burton Ct - Applications/Water Heater - 09/01/2017Sep 01 1712:47p Hahn plumbing City of 970-493-5325 p.1 plau=_rringr 7eveloo rant & TranspoenXtion 261N. Coflege five P.O. Box 5S0 Fort Collins, CO SD524 Phone 970-4i6-2740 Fa:??46334 AUTH,=ai�,1� ; it }'�i PEA'--yMIR tj' 1 1 {I \i t !j r �- This application is to be used to apply -,'or the iolloeyrn o J Y yi 9 permits only (chealc all that apply). p Air Conditioning ❑ Demolition (interior non-structural) 0 Electrical Alteration (not sen4ce change) 12 Gas Lighter ❑ Gas Log 0 Hasi ing Unit 0 Laven Sprinkler ❑ Nlobile Home replacement n Rooiing C] Sewter Line ,12 Photo -voltaic 12 Ventilation !Water Heater 0 Water line Q WoodlPepet Stove (must be EPA certiiled, protilde make, model and manufacturer)_ Complete all applicable information on the spP.Gceiion. lncompleie apgllcailo_ns will not be accepted Appiicatiori -7 Dal~ __ , • , `� Foromce use y Job Si, r d ss (regtdred) 'Value 0; Construction (la r n -� , materials, p O' O oFertY Owner Name Address r pg -scant Name Address cirylstate r_ i I : _ , _ . I zip Phone Conrracor J,r r Address Ctylstab+ Mp Phone Contractor City or Ft. Collins S -s Tax = r .-I P_ Sales hxnumberisrrquAedb aU lj in_ you paving taxes here or by report? L7 Here i�;Ret I '�, A'-e you PaYrng WithYour trust account? XYes o rub is ales a re-9dential or, co , merciai project? Residen--- =i r+esfden6al, is it Single Family Data tial f,I' Commerdat d>zd 0 CandgkOwnhome (single family attached) - • E3 Duplex Q Muitifamrly r (apar ent) B Garage :P commercial, is It ❑ Sank © Bar 0 Church 1, Hotel/Motel D Mecical once Ci circa tp Retail © Restaurant 9 Other (explain) is this building 50 years of age or mot? E3 Yes CI No U if this is for a dernolitlon per rrsik What year was the bulding cow Ynstruc��d? need io mrliaCtll�orrtPreserraiian Ir prior to 3973, you .wN need all aMwws asszssment to Submit yu/ch this appilotba Description of work CIF lawn sArinl'Jer/bactoow Pre "venter, must fist: Licensed tre. piumbFrst-i�lte 1 must list 11eens2d �ecyrican . S U%Con•U cCtom List the campsnyname of Ci7vorl� Col�Jn Plumber, Electr'c'-an t'4rmber ,Mr R00' Omer I hEfeby aCkno'111edga that I have read this appilwdon and state that the above tnfomnahon Is wmpJaM and ocrrect I agree to con"ipg"vith all rWulreMents contained ;herein and dty orcffronew-and state lays regulating building construcrioe. S laiew ahak a permitis no=Valid until $'has been paid and issued. Print Mame: Sia2 � ' t .l gni�t!� Date