HomeMy WebLinkAbout2845 Canby Way - Applications/Water Heater - 01/02/2018Planning, Dwelc
281 N. College Ave
Fort Collins, CO go!
Phone 970-416-274
K
OVER-THE-COUNTER PERMITS.
i l.:s application is to be used Ito apply for the following permits only (check all t
pamolition (interior non-s ural) ❑ Sectrical Alteration (not service change) ❑
L I heating Unit la Lawn Spdnk er ❑ Mobile Home replacement ❑ Roofing ❑ Sam
f i ventilation ater Heater Fr] Water Line ❑ WoQd/Pellet Stove (must be EPA cc
ri inuiacturer)
Complete all applicable infornf ation on the
application. Incomplete applications
\,"Applioadon # I�'0yC 1 Date
For olTice use oitl�
Too Site Address (r Ir2d) i Value of Construct
1:11- derty Owner Name Addrets City/State
i; �hlractur,v,.
Ft. Collins S" Tax #
�:fxtr�„mnrberisrepuA
Is this a residential or
tf tesklenbal; is tl:
/ ❑ Multifamil
l ii annmerdal, is it: ❑ Bank ❑
❑ Restaurar
hi_; Iwilding So years of age i
rr ;ail; is for a demolition per•i t
Lair to 1975, you will need an
ntscrip�io11 of work _
• 6a
Adress City/State
`1l-
rent & Transportatioii, l)
P.O. Box 58U
I /17
Fax 224-6134
ONLY
at apply). ❑ Air Condifiorrnij
as Lighter ❑ Gas Log:
r Line ❑ Photo -voltaic
ified, provide make, modal
rill not be accepted.
i (labor,Analerials, pront)
a-7 7-
Zip Phone I
Zip Phate
Are you paying taxes here or y report? ❑ Here Ref
Are you paying with your � a&:ouht? 1pes ❑ No
r'447 q4teslqpnVal ❑ Commercial
Hy DetachDetach6d D Condo/townhome (single family atta Jaed) ❑ Duplex
(a*6nerit) ❑Gauge
ar ❑ Church ❑ Hobel/Motel ❑ Medical office ❑ Office 13 Retail
❑ Other (explain)
more? ❑ Yes O No ifyes, you may need to covitE ct Hlstwic preservation
what year was the building constructed?
bestos assessment to .Submit wilt this appllcadon.
if lawn sprinkler/backliow prevenai, must list licensed plumb&. If first-time A/C, must i1st iii
S:tbcontrectors: Ugthe campany!name orGtyofFtColrns11awse T
i .IrC(riu:,n_. __- Plumber. _ Mechanical—_-- Roofer_,
,
:,, „•hy aclorowledye that I have read this application and state that the above information is
„taiily with all requirements contaided herein and city ordinances and state laws regulating bt
snit is rot valid until It has been paid and issued.
electrician.
i to
ortf
i
i
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_ Olher
=te and mnect I agree in
conSlruction. Ilu:owthat.,;
o I
�t_l-t-i- —►-c'f14�_-S� gnaraintNanh.J.+ i /
Late
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