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HomeMy WebLinkAbout2921 Timberwood Dr - Applications/Water Heater - 11/30/2016Dec 14 16 07:25p Ellmann Service Cc 9702233324 p.2 Cfty lof Planning, Development & Transportation p e� 281 N. College Ave. -P.O. Box 580 „wortCotti s Fort Collins, CO 80524 �.� Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be us -ad to apply for the following permits only (clieck all that apply). 0 Air Condfioning 17 Demolition (interior nonstructura) ❑ eectrical Akeration (noiservlce change) D Gas lighter Q Gas Log , El Healing [lnit 0 Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing 0 Sewer Line 0 Photo -voltaic Ef Ventilation ❑ Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, providemake, model and manufarlurer). complete all appl le lnfohrmation on a application_ incomplete applications will not be accepted. Application # L w a* - O Date 1 ��� ( (y} Forof99c2 c� ony _. Job SitaAdd ass-(+equped)Value.of constm.ction (labor, materials, -profit) WOC)4 �'Ntr. _41— $ 7(r)L,-`7%n [AWL' l/)TYY�f- D� ELU � L V C 1.1 Applrcant Name� 8 o rr i � 402 �709 Address city/state rp Phone Connector Llc # Address C1ty/St3te Zip phone S/gn-rR SA;1 ra- � �r r Contractor City of FL Collins Sales Tax # 3.z�c,f— Are you paying taxes here or by report? ❑ Here WReport .ales 1arnum6er&tegrwpyalcantraaius Are you paying with your trust account? gyes I] No IS this a residential or commercial project? OResidential p Commercial If residential, Is IC 0Single Family Detached 13 Condoftownhome (single family attached) 0 Duplex 0 Multifamliy (apartment) 17 Garage ifa mmucial, is it: C3 Sank _ © Bar _0 Church ElHotel/Motel D Medical ofFice ..0 Office II Retall 0! Restaurant ❑ Other (explain) Is this building 58 years of age or more? ❑ yes ❑ No rryc* ytw mayf, t.? avy, cth4ttapicPreservapvn If t11is is fora d®molitibff per iif� vwh6t year was-tile"buHdirig-�-. __. prior f0 19VS, ytw WR need an asbestos assessment 10 submltcvib5 I&S; cp pWA DesWptiorl of *If lawn sprinklerlbackfow preventer, must list licensed plumber. If firA-bnm A/C; must list licensed Subcontractors: List the comp"yname orGlyof&CollLrsOcense 0 Bectriti�-----_.� Plumber _ _ - MechaalcalL. hooter Outer j I hereby acknowtedge taut I have read thb apAiicetion and state that the above intbrrnation Is comply with art reglh ments contained herein and clh+ ordinances and state laws regulating bu&*nplm and don.correct I agree to permit is Oct vogd urrtH It has been pahJ and Issued. 9 construconZ kn. that a Appilcant: _ print iVartree Date;