HomeMy WebLinkAbout5620 Fossil Creek Pkwy - Applications/Water Heater - 12/19/2017Planning, duel
: 281 IV. College,
fFort Collins, CO
Phone 970-416-
01VERi.:THE-COUNTERPERMITS
i !.•s Ipplication is to be usedlo apply fortha following permits only (check all t!
i l.+n,olibon (intenorron-structural) ❑ Electrical Alteration (not service change) ❑
I Heating Unit ❑ Lawn Sprinkle? ❑ Mobile Home replacement ❑ Roofing ❑ Sew
r i Ventilation ter Heater Q Water Une O WoodlPellet Stove (must be EPA ce
iiianuracturer) i
(,oiliptote all applicabblee1lnfflo�riniation on tileappllca#ion, Incomplete applications
�;�pFiication �r—_y ` ``� q)Q-1 `e� Date
I -or afflci use onik
1ou S;ie Addrass (vc�
5 tn2b
I oapci ty Owner Name
Aoohcant alale- ,
t .YKi�,,
t; iui,rac0r'-
ia .a•.'
Address
Address
Value of
,
City/State
City/State
City/State
vent & Transportation
P.O. Box 580
I
Fax 224-61 4
O N VY
at apply). ❑ Air Conditlonmt i
as Lighter D Gas Log a
r Line ❑ Photo-voltalC
ified, provide make, modal ,.i1
�ryvt— -
r�nhtb aclror Ci(y of Ft. Collins Sal'�S Tax Are You paying taxes here di
aun;&^ Isrequlredbyall con crors Are you paying with your h'U
Is Uus a iasldeiitial or cdinmeraal�ptroject? 'c)ential [9 Commercial
it i e i�!enual, is it Single Fa it Detach d E7 CAndo/townhome (single family atta
❑ Muld miiI artrner(t) o"I] Garage
i co-nmercial, is il: ❑ Bank ❑1Bar ❑ Cbu_rch ❑ Hotel/Motel ❑ Medical office ❑ C
❑ Restau2 ❑Oilier (eicpiain)
!ii, I-nulduig SD +/cabs of -' e r more? ❑Yes O No 7fyeS, you may need to conk
.il; is for a demolition pe'rinii� what year.was the building constructed?
ll, it to 1975, Wtiu will need an asb'estos assessment to submit with this application.
l)aScripnon of work _ _ P � -1 —
if 1„wn sprnikler/backilow preventet, must lisAtcen plumber. If first-time A/C, must list lic
5-.;-con;a-actors: List the mmpahAname orG•tyofACollins license #
Plumber`__---- Mechanical_--.__— Roofer _.
:n• .WO, acknowledge Ulal I have read this applicaUon and state that the above information Is
•iniily with all requirements contaiged herein and aLy ordinances and state laws regulating bi
=ri It is rot valid until it has bden paid and issued.
not be accepted
(labor, materials, pruiity
Zlp.—
Phnnp ~
+
J
Phone
Zip Phone
y report? ❑ Here Report i
account? 'ryes C] No
ned) ❑ DuPI&x
i
lice ❑ Retail ;
. t Hlstov is Preserva bon
electrician
—_ - ouler_.
>_te and coricd t agree r
constrtic!lon
I kno
w
t
hat tic
i
-
E
orirrheinat:erte ��"tali
I