HomeMy WebLinkAbout820 Scenic Dr - Applications/Water Heater - 12/18/2017Planning, Develc
281 N. College Ave
Fort Collins, CO 80!
Phone 970-416-271
Ira PERNIM
i'.-s .,pplicati,tn is to be used 'to apply for the following permits only (check all tl
%:•n,olition (interior non-structural) ❑ Electrical Alteration (not service change) ❑
t I Hating Unit Cl Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sew
I Ventilaboll i Water Heater Fr] Water Line ❑ Wood/Pellet Stove (must be EPA ce
manufacturer)
tom;dote ail applicable inforriation on the application. incomplete applications
lvr ofce usd of
1
700 :,te Address (r��/uirddl
Pl;,pel ty Owner Name
Iv . V,,-,
-A000lirr)nt ante,,. tkuurras
Address
i;sulraclo i LAW
Cobb I Cobb actor City of Ft. Collins Salts Tax #
I h u%,turribarnrdqulTdbydllwnb'ectom
Date
Valve of Construct
City/State —
City/State
City/State
Lt: rreiis to
Are you paying taxes here or
Are you paying with your tru.,
vent & Transporta doll
P 0. Box 5&0
Fax 224 613?
r
"OV`I
9t apply). ❑ Air Concirtioi Mini,
as Lighter ❑ Gas Log
r Line ❑ Photo-vottaic
ifed, provide make mocloi -. .
is tills a I:sidential or_2qrimeidal ir: I uj:':::cq iis dential 11 Commercial
[i klenual; is it le Family Detach d ❑ Condo/townhome (sngle family atta,
❑ Multifamily (apartment) ❑ Garage
i it commercial, Is It: ❑ Bank El Bar ❑ Church ❑ Hotei/Motel ❑ Medical office ❑ C
❑ Restaurant ❑ Other (explain)
i i l; litilding SD years of age or more? ❑ Yes ❑ No Ifyes, you may need to contE
is for a demolition permit, what year was the building constructed?
• ,jo, to 1975, you iv/il need an �sbestcs assessment to submit with this aPPAcation.
pull onofwork__
11 not be accepted
�aild,r7
n (labor, materials, pivfiL+
all
Zip ' Phone '
Zip Phone
Zip Phone
y report? ❑ Here 19Reooit F
account? 'iYYes ❑ No
hed) ❑ Uuplax I
-{ice ❑ Retail
.t HlstoJrc Preservanon
If 1„ovn tipi inkier/backFlow preventer, must list licensed plumber. If first-time A/C, must list Ilc I
5 --,xoe lira dor s: 1 i t 0?e cnmp,7nl name or otyof Ft Collins license m
jI�•,viu-,,L• _--_ __- __ Ijlumber___ _ Medianlcal______— Roofer--
-- ---- - —_'
by ici,11owledge that I have read Lhis application and state that the above information is
„iniiiy with all requirements contained herein and city ordinances and state laws regulating but
electrician
Other - _
ipiete and cot IeCL t agree i,
'Iq construcbou. I kr,00v that
r"t is cat v_,Ird u.ru„ iL ras een pa. an issue .
o �
iz:^:e� _ lrrn V V11 l't C+ tt ignatvre _ :.,.