HomeMy WebLinkAbout1907 Etton Dr - Applications/Water Heater - 12/11/2017DwieWparest&1 -
NI N. College Ave P.O. Bm 580
r t Cod ins Fort Collins, CO 80524
��-•r - Phone 970-416-2740 Fax 224-6134
MM-THE-MUMMPERMS ONLY
ibis application is to be user# to apply :or the ollowing permr s earnly (check aU titan apply). ❑Air Co Of
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
G Heating UnLaw Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer li�o
Line 0 Pha-vOilim
0 Ventilation Mfter Heater 0 Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer] will notComplete all app�'e in€ormation on the appfiCation- IncompkAe apP ns be accepted.
Application #
Date IoZ—//--/7
Value Ud Construdion (o+w.i "we"�i profit) I
Sob SUM Acid B'43 Cre c
r i
Property owner Na a Address CRy/ate ZIP Phone
Applicant Name Address arty/State ZIP Phone
(( SGGi �v;'L�Shii-L( C-7Gtr"[Cu-d-%( —ISU4.3
Contractor` Address- City/State ZIP Phone j
i
Contractor City of Ft. Collins Sales Tax ¢ Are you paying taxes here or by report? 0 Here ❑Report
Are you paying with your trust account? 0 Yes 0 No
$ems tax number is required by an co
IS this a residential or 03mmeclal Project? ' 0 Residential ❑ Commercial
If residential, is it )(Single Family Detached 0 Condoltnwnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is lL ❑ Bank 0 Bar 0 Church Q MteilMotel 0 Medical Office ❑ Office 0 Retail
0 Resi-ateant 0 odw(e Vain)
Is th6 building So yews of age or more? ❑ Yes 0 No it yes, you may need to contact H'6mric Preservation
If this is for a demo ion permits, what year was the building constructed?
If prior to 1975, you will creel an asbestos assessment to submit with this application.
Description of work
J
'If lawn Sprnnlcl2ribadvloti4 prevails, rnusc list licensed plumber. If first-time A/C, must list 11103'EM electrician-
Subamtracitoii List the rbmpany name or 6iy of Ft Collins hcz'nsa 3
Hen pkmdxw Medmrk i Rooter. Other -
I hereby ad nmiedge that I have read lids appikebon and state that the above infrnmation is mnpiete and correct I agree to
contained herein and city ordinances and state laws regulating building construchm I know that a
comply with all requirements
permr"t is not valid nnnib it has been Peid and iSSue d-
r 7�
Appliicai� l i n de ( t
Print Name: , _ n i n 4 Asa lure