HomeMy WebLinkAbout2921 Timberwood Dr - Applications/Water Heater - 01/25/2018of Planning, Development & Transportation
L 281 N. College Ave P
Collins Fort Collins, CO 80524 .O. Box 5ti0
Phone 970-415-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
lis application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
Demolition (interior non-structural) O Electrical Alteration (not service change) 0 Gas tighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ PhotD-voltaic
VentilationA•Waber Heater ❑ Water Lute ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
all applicable information on the application.
)n #_ $ 100a-
Por ofik a rrse only
Incomplete applications will not be accepted.
Date Iasl►�
ob Site r!.ss (V#LV value of Construction (labor, materials, profit)
G:rcOdw Address 55I5 OWStgPhone Ei
l� i�TG 5k Sor(.I 402 Sao`}
plicant Name Address CrLy/Slate Zip Pho 331Z.
S�pu � 1o52
ontractor t ///1')%9r1�I Add CRY/State ZIPoi6p 7z:3
El2v�rc I ccE zuc— P- 331
ontractor City of Ft, Collins Sales Tax #-36 20g Are you Paying taxes here or by report? 0 Here AQeport
aaxnrrmberes, vesbyaHcwrbaaws Are you paying with your trust account? .Yes ❑ No
%this a residential or commercial project? XResidential D Commercial
residential, Is it. 04jingie. Family Detached 13 Condo/bumhome (single family attached) 13 Duplex
C Multifamily (apartment) ❑ Garage
commercial, is it. 10 Bank E3 Bar ❑ Church ❑ Hotel/Motel O Medical office 13 office ❑ Retail
17 Restaurant 0 Other (explain)
this building 50 years of age or more? 0 Yes D No Jrfyq�s, yrwnW"- egedtvuxrla�tiia iC PT bon
this is for a demolition permit, what year was the building constructed?
prior to 194 you will need an asbestos asse-wrx t to submit with this appldwlyon.
of work
a
lawn spvinkkr/bacKow prevmter, must list lid plumber. If first time A/C, must Get Soensed eJedritian.
Gist the company name or Cly of Ft Cotins l rim if
Plumber = tedfaakai Roofer 011ter
r aclamwtedge that I have read this application and state that the above k formatlon is complete and correct. I agree to
with all requirements contained herein and city ordinances and stabs laws regulating building mnzvction. I throw that a .
Is not valid until it has been paid and issued.
oa�e 12 i Sh 7
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