HomeMy WebLinkAbout3344 Golden Currant Blvd - Applications/Water Heater - 02/08/2017ins
Planning, Development & i t'ansportaticr•
281 N. College Ave P.O. Box 530
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER—THEE.-COUNTERPEif'3MM ONUS
7!;!s applicaflon is to be used to apply for the following permits only (check all that apply). ❑ Air Conditirriny
Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
t7 Haating Unit ❑ Lawn Sprinoer ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
i i Ventilation ater Heater (:I
Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make. modal id
manufacturer)
Complete all apolicabta Information on the application. Incomplete applications will not be accaptad
Application /, _ b no D 5�— Date -- —._-- _-.
ror o/flce use only
j 3ob Site Address /i uirzd) Value of Consbma on (labor, materlaals, profit) J
Property Owner Name `/', Address City/State Ip Phone
A' plicanC Nan 1 Address fate t!p Phone
C1,,,� 1 e„ A 1 ifs l -,;. Lime IN. FG 60 ID5all "to_ - yegll
umtractor,� I Address City/State — . Zip 'hone
�Re ort
Contractor City of Ft. Collins Sales Tax Are you paying taxes here or by report? ❑Here p
isr2qu/redbyall a"rrlactors Are you paying with your trust account? 1AYes ❑ No
i—
Is Uti; a residential or coercial'projecO esidential ❑ Commercial
If reskkntial, is It: Single FaT ily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamil�(apartment) ❑ Garage
1f commercial, is it: ❑ Bank ❑ Bar' ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
.Tits building So years of age qr more? ❑ Yes ❑ No If yes, you may need to contactHism0cpreservadvil
l;' this is for a demolition permit, what year was the building constructed?
,7 �r to 1975 yvu will need an asbestos assessment to submit witb this applioNon.
I)escrption of work
U U,2_1_lJV1/�
If inwn sprinkler/backflow prevenber, must list licensed plumber. Ir first-time A/C, must list licensed eiectriclan.
Su �co::tiactors: List lha rompanyname or Gty of Ft Collrns license 7
Plumber-- Mechanical_ — Roofeer_--_--- •-. OUier
by acknowledge that I have read this application and state that the above information Is complete and correct. I agree ra
,�i;;I:ly with all requirements contained herein and city ordinances and state laws regulating building construction. 1 know sat E
;;ar^pit is riot valid un'LA It has been paid and issued.
o:.i)iJ:: G?ill: �.p� ,nature
^n` Name Qti �& �] date
ire Y JL -