HomeMy WebLinkAbout4578 Seaboard Ln - Applications/Water Heater - 11/09/20181p�:rr+[x i'(�`itWo 'cn'` r" 5: 3 y1 3'�I✓I ? �`�' 4 F p
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��i l;O�tI�nC� Comilluni r Development G Neighborhood Services
281 North College Avenue
east Collins. CO 805244 Fllain: 970.415.2740 Fax. 970.224_613e
This application is to be used to apply for the following permits only (checic all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Q Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilations Water Heater ❑ Water Line ❑ Wood/PelletStove (must be EPA gentled, provide make. model and
manufacturer
Compleie all applicable intornation on the application. inconpleis applications will not be accepted.
Application = 6 W `"i "//`1 Date 11• 9 -
For once use only
1 od-b'tote Address (raquired) Co �ctiora (labor, m rials, pro
l Properi/ Owner fume Address City/State 1p Phone
i Rndrer> ,�udltilns ,loll �4aver tll PLr Colarod� E)M ,CO W919 I i Applicant Name Address Citylstate Zia Phone
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Contractor Address City/State Zip d I Phone
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Contractor Gty of Ft. Cal[ins Sales Tax _ M0m .l Are you paying taxes here or by report? ❑ Here ❑ Report
sales las number is raquirad b" aff mnir ctors. Are you paying U!ith your trust account?'K Yes ❑Flo
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! is this a residential or mmerclal project? ig Residential ❑ Commercial
if residential, is it: Single Family Detached 0Condo/townhome (single family attached) El Duplex
Multifamily (apartment) ❑ Garage
it commercial, is it: 01 Bank 1 Bar ❑ Church 13•HoteVIVIotel El Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this buiiding 50 Jea:-s of age or more? 0 Yes ❑ Plo lryes, you may need fb COnrdCL•H%SrOI c Pr?seNatian
ri this Is For a de:v oiiition pBrinit, what year was the building constructed?
Description of work AP-plr,ced 50 q Callan QC, LAl/N
'if lawn sprinkler/backrloiv preventer, must list licensed plumber. s y rsk e E,/C,r runs_ Hsi Saeer.5eel e2ecb das .
Oubcon: aecers:UscPhecomoanynameoi-Gryo,`rrCollinslicense.=
Electrician Plumber Medienical Roofer Other 1
a hereby acknowledge thatl have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. 3 know that a
1-ermit is no. Valid +=ritii it has been Paid and. issued.
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