HomeMy WebLinkAbout633 Armstrong Ave - Applications/Water Heater - 01/02/2019City of Planning, Development & Transportation Services
F6N Collins Community Development & Neighborhood Services
�- 281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fat 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Healing Unit � Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation � Water Heater ❑ Water Line ❑ WoodlPd let Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable informrr11ati/o'n� on the application. Incomplete applications will not be accepted.
Application # V U Date ra,uta.ry 2, 2019
rarolrceLs- a*
Job Site Address ftqudad) Value of Construction (labor, materials, profit)
633 Arm2tror g Av&FortCoijAw, CO 80521 $1920.00
Property Owner Name Address city/ate zip Phone
Ma#-1&CalIaha.n, 633 Arm6trmitAv& FortCoilinb, CO 80521 970-420-5031
Applicant Name Address city/State Zip Phone
0u^&WVAa1EVa4U 101 S LfrtkLa i& Ftco; CO 80524 494-7632
Contractor Address City/state Zpp Phone
AUAe4 ,SpyvLce 101 S LLwk.Lane Ftco, CO 80524 484-4841
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by moil? ❑Mere ❑ Report
sarstax winbertsreW&&bya# Are you paying with your trust account? VYes ❑ No
10010
Is this a residential or �nera project? r Residential ❑ Crimmetcial
If residential, is it: 1W Single Family Detached ❑ Condo/l ownhorne (single family attached) ❑ Duplex
❑ Muliffardly (aparbnent) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/MoMJ ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Yyesy you mayneed to contact /&uric Preserm6bn
If this is far a demolition permit, what year was the building constructed?
Descriptionafwork F'e*wve`e`Y'C6anW w/lva*u" replafewidvnewUk.&w/iv
*If lawn sp inlder/bacldiow preventer, must list licensed plumber. If first-time A/C, must fist licensed elecWdan.
Subcontractom List the cmwnynwworOlyofftColErs/ram-d
9ediidw Plumber Mechanical Roofer other
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I hereby acknowledge that I have read this application and state that the above information is complete and correct I agree to
comply with all requirements contained herein and oily ordinances and state laws regulating building construction. I know that a
permit is not valid urib9 it has been paid and issued, , /► _ /� Applicant: CjW(4rL4 VFVAdt� Nr�)lJll�l/1Print Name•Signaturei
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