HomeMy WebLinkAbout2609 Killdeer Dr - Applications/Water Heater - 09/13/2018-��t Collins Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970A162740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer line ❑ Photo -voltaic
❑ Ventilation V Water Heater ❑ Water Line ❑ Wood/Petiet Stove (must be EPA certified, provide make, model and
manufacturer).
complete air apprrcabie intonnation on the application.
Application # R I cb b-1 q �2
For wkewea*
Incomplete applications wi i not be accepted.
Date 9 (3 1
cob Site Address pagr®a) Value of Construction (labor, materials, prpft)
UA kA Ide2,r br 145q( bD
Property Owner Name Address . City/State Zip Phone
Applicant Name
Address City/State Zip Phone
�� 303 tom- s7�5
Contractor Addres.s ty/State Zip Phone
CSC -ra3�� lc/ Cb 85;Q9 303-ego-5165
Contractor City of F Co ' Sales T # Are you paying taxes here or by report? Here ❑ Report
Safes tarrawa risreguhdbyatlmrrtacbm Are you paying with your trust am"", s ❑ No
Is this a residential or oo erdal project? Residential ❑ Commercial
// \\
If residential, is it ngle family ❑ Condo/townhome (single family agent) ❑ M49e c
❑ Multifarrnly (apartment) ❑ Garage
If commercial, is r1= ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Matel ❑ Medical office 0 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this bU110tg 50 years of age or more? O Yes O No lfYes Yw may need m cnrrfaa ffz&vk P1e & a&on
If this is for a demolition perm ft what year was the build -mg catstrrcbed?
Description of Work C.U1L 3
*If farm sprinift/baddlow prevent er must list licensed plumber. If fks1L time A/C, must list Licensed eiech idan.
Subeonbactorsrwthe coqOrvrynameorCytyofR02m &mse#
Electrician Plumber Mecharicai Roofer Odw
I hereby admowledge that I have read this application and state that the above information is complete and correct. I agree bo
comply with all requirements contained herein and dty ordinances and state laws regulaft bwldhg construction, I know that a
Permit is not valid until it has been paid and issued
Applicant: print ( /1L'Y1Url�ak i, t( Print Name: Data UU
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