HomeMy WebLinkAbout3506 Colony Dr - Applications/Water Heater - 01/20/2017Planning, Davelopment & i is ls!�ortzt a,!
281 N. College Ave P.O. Box 581!
Fort Collins, CO 60524
Phone 970-416-2740 Fax 2J_ i-o13
i !;is a.p.ilicatioa is to be used to apply for the folloWing permits only {check all that apply). CJ AIr Cordia„Ci:7,;
._! "A-nwiition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lightzr ❑Gas Loft
I li -piing Unites Li Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
i Veniilaaon l�Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, providie niaka. in rai
k;oonpl to all api.iiicable lnfonnation on the application. Incomplete applications V11I1 not be @rcapl8d
\pPlic itioll I` _-- I IOU--
1•-or ofr-cc use only
''oi�Sita:�d3i?s5-(rcy]f/%!2[1)
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Pr;.perty Owner Name_ `Address
Address
WE
rr:,cl,ir Address
Date
Value of Construction (labor, n-aLeli&,
*pruri
I' 7-5-7c o 00asz � -- ---
City/State ZIr�n_
�iM)?is'-
State Zip Fhorl_
City/State Zip Phan::
:urdractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? f] iiare epgrr
ra, ,mmbsLrreq Tllcontiactors -- Are you paying with your trust account? 19?Yes ! Pa-.
); ti us d i 251duIlUal Ur conerdal—project? esidential ❑ Commercial
'r ily attached) ❑ Duplex
r•e,i,!enria!, is It: Single Family Detached ❑ Condo/townhome (single fam
❑ Multifamily (apartment) ❑ Garage
li crn!rniercial, I-; It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑Office ❑ Reiail
Restaurant ❑ Other (explain)
:.
hiiildi!Ig So years of age or morel ❑ Yes ❑ No Ifyes, you may need to contact /lisloric Prttsarvad w
ti; :s ur a damoliiion perintk, what year was the building constructed?-
n W to l P75, you mil need an asbestos assessment to submit with this appll,adon.
il•}5Cfipll Orl of WOrk
if laveu •;pritimtr/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Ss:;co::uactc, s: Lisp the cvmpany name or Gty of Collins license
JU cl d
wunrber__.__ Mechanipl__--- Roofer---'.---- •-.
t•r :Ida:ovalc,lye Uial 1 have read this application and slate that the above information is complete and corll;CL I agl 't t-
;:iy with all requirements contained herein and city ordinances and state laws regulating building construcdcm..i
M: iS i!Ot vz !I,,!Uil%i it has been paid and issued.
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-i; -���SignatureY 1+-�. --- ----� ate