HomeMy WebLinkAbout7438 Stonington Ct - Applications/Water Heater - 02/20/2017Fort Collinse.
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Planning, Development a Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application Is to Eaed toTHE-COUNTER PERMITS ONLY
❑ Demolition (interior non-structural) ❑ Electrical Alteratioapply for the n Permits only (check a AJr
(not service change) ❑ Gas Lighterll that apply ❑❑ GasoLogoning
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation lFWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all aPPI le--il1nfonnadpon on the application. Incomplete applications will not be accepted.
Application # 1 7 00 O J g pate
For oAkr rrse Of*
Job Sibs Address (reputed) Value of Construction (labor, materials, proftt)
Property Owner Name Address
City/State ZjP Phone
Applicant Name t5
Address City/State ZIP Phone
Contractor Uc # Address city/State
�nrrniarr yir rii1� #-/ 73,E a ZIP Phone
5(0 (E 'Idarn W�rSO� CD. p U53O 970
Contractor city of Ft Collins Sales Tax # Are you paying taxes here or
S�lestarManl [siaqulieybj as 3934// Are You Paying with your trust account? by report? Y-es ,.0 ere RN ort
lr.elf Bar®
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is It lr�single Family Detached ❑ Condo/tnwnhome (single family attached) ❑ Duplex
❑ Multlfamlly (apartment) 0 Garage
If commercial, Is It: ❑ Bank ❑ Bar E3 Church E3 Hobel/Mcbel ❑ Medical office ❑ Office ❑ Reap
❑ Restaurant 0 other (explain)
Is this building 50 years of age or %morel O Yes "0 Ifyes, yrw may,need m wniad N�dc Amwmvon
If this Is for a demolition permit, what year was the building constructed?
IfMOr m 1975, Ym Wll need en went In wbnxt cold► di,(s aPe//[adnn
Desaiption of work
*If lawn sprinlder/baddiow prev�rrber, must M kensed plumber. If first-time A/C, must list licensed electrician.
Subeontr�a�ebots; LLsn` Me company name or Oty offt Collins /C&W it
6ectiidan�%%rfat! rC�', PlurttberMeftniral
Roofer. Other
I hereby acknowledge that I have read this application and state that the above informatlon is complete and mnecL I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
Permit is not valid until It has been paid and Issued.
l / [ e�C%
Print Name: �'� �rGt=l.[� l� Signature�_
Date ,7 -2o _ /7