HomeMy WebLinkAbout3028 Tulane Dr - Applications/Water Heater - 10/10/2017planning, Develop ent&Tra,nsportatio„
281 N. College Ave P.O. Box 580
1�1'01 jn Fort Collins, co 805 4
1" Phone 970-416-27 Fax 22+6134
OVER-THE-COUNTER PERMIT . 0N LY
i t,is application is to be usedlo apply forthe following permits only (checl(al]tion (not service change) D as Lighter ❑ Gas Log
at apply). ❑Air Conditlonlny
_ Demolition (interior non-stru ural) ❑ Electrical Altera
I. I Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home repEacement D Roofing Q Se . r Line ❑ Photo -voltaic
• V n tilation iL7ater Heater Q Water Line ❑ WOQd/Pellet Stove (must be EPA ce flied, provide make. medal :•aria
, ; e
r;anuracturery.
Complete all applicable Infornpation on the application. Incompletaa appllcatl(
""�r\pplicatiorl
Date
;r �!
\ Phr. o !rce use,onq
Joi) Site Address (r.lulmd)
Value of Consb
3028 i
_
Property Owner Name . I Address
. Ctiy/State
Aoolic�7nt alllee - dress
City/State
�ddiess
: ` Clay/Stage
Contractor
;.:l::: u.� „omberis(�4ulmdGyaU ca
is tais a rasldentlaior mere
if resldentt5k is it: Single
❑ Mt i_fal
l if oaaunerdal, is it: D Bank
0 Restaui
I :s rims building 5D years ofag
r; itai; Is for a demolltloo pari
2.'4yi.vto 1975, you idtllneed
I)as-- tion of work _
' if lawn sprinkler/backnow preven
i s:;b.-ont;actors: Ut t Md mmpal
Plural
: o eohy acknowledge t hat I have
„nq;ly with all requirements cant
:;_unit is not valid until it has
c # Are You paying t L h2r
Are you paying wftf gout
oject?. Resideril al f3 Cominerdal
ly oetao ed b Condo/towrihome (single family at
aparFmenh) 0 Garage
ar i1 Chutdt D F{utel/Motel ❑ Medical otiice 13
❑ Other: (explain)
fttore? ❑ Yes .O No. if you may need to coc
what year was. the bull lding, cotts4ud d7
estos assessment tosvbrnit wlbi this appllcadorr.
t--..-
P, must fist Iicetised plumber. TT first-tffne A/C, trust list
name or MY ea alOnsllcense ,Y
MechanlcaL ___—.— Roofer
this appiicatlon and state that the above information is
herein and dry ordinances and state laws regulating bi
i paid and issued.
not be accepted:
(labor, materiaJs, profit) -
1 9 4.5 i
4
-i- — Phone
�r37X
PI no e1
,y report? l7. Here Z6Report
accod"nt?. VY9 ❑ No
ed) ❑ Duplex
ce D Retail i
H1slor6presenadon I
other
ate and correct. I agree m
construction. I kr:Mthatil
1-
i
PnntNar.:eA �Ttit_ L,—'u� ;ignatvrey _vate 0Il� /