HomeMy WebLinkAbout1655 Streamside Dr - Applications/Water Heater - 12/06/2016Planning, Development 8C'i ransportadc;1
281 N. College Ave P.O. Bo% 590
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22=1.61.; c
i :: s application is ca be used to apply for the following permits only (check all that apply). 0 Aa Conditic;
_( _1,%owlition (incedor non-structural) ❑ Electrical Alteration (not service change) ❑Gas Lighter t ;Gas Log
I ! I ating Unit ;-'i Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic,
i Vantilauo � ater Heater El Water Line ❑ Wood/Pellet Stove (must be EPA certified, provides mak>.
;n.zli J:acturer)
I1on plate all ai uiicabla infjormation on the application. incomplete application1s�wi�llnot be
accepter!
\oulicition ;. _ 1 Date _1 if 2!2
!-or olnce use only
Value of Construction (labor, m�ileiieIs, prorit
Job Sita Address (ra7ulred) ( mom°
< i g��zs' Li $
r� Cit -
l'r..aerty Owner Name_ Address City/State Zip it.,
i rN)licxvitNam Addressity/Stat Zip ho,ea
enractorA_ Address City/State Zip Phan
:01
ul Itiactor City of Ft. Collins Sales Tax 7p Are you paying taxes here u by report? ere a o
Are you paying with our trust account? iYes .I N
urmha'isrY/uiraibr/al/cvnfrddors Y P Y 9 Y
is Uiis a iasidLnUal or con}�ercial project? Residential 0 Commercial
is re,l lential, is it: B`51ngle Family Detached ElCondo/townhome (single Family attached) ❑ �upiz:<
❑ Multifamily (apartment) ❑ Garage
it commercial, is it: ❑ Bank ❑.Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail .
CI Restaurant ❑ Other (explain) -- -
r::; hmiding so years of age or more? ❑ Yes ❑ No if yes, you may need to Contact l-I/slarlcpreservatinrr
;s cur a damolition permit, what year was the building constructed?
a r, :r to 1975, you ;Hyil need an asbestos assessment to submit wiffi tfiis application.
D• aipiion of work f`)Ie" _U _—�✓ -
[Hawn ,prinkier/backflow preventer, must list licensed plumber.
Cf first-time A/C, must list licensed electrician.
5; co!:tra ctors: U.tt Lh�� company name ar aty of Collins license
Med.anica — Roofer _— ..-_-- '�U �•-1 --.
arknowledye that. i have read this application and state that the above information is complete and con'ea..
;;Tv with all requirements contained herein and city ordinances and state laws regulating building consUudion. i know th
a c
is not val'sd urz., it bass �been pad and issued.
Signature a&__ --� — r ate l�l Lliv / 7Ct f �i