HomeMy WebLinkAbout2315 Clipper Way - Applications/Water Heater - 03/10/2017Planning, Development & Tranzportau,!
281 N. College Ave P.O. Bo:,, SW
Fort Collins, CO 805211
Phone 970-416-2740 Fax 2246!34
P-5 ONLY
ilk-(X UNTL
is to be used to apply ,or the foliowing peranits only (check all thaLappJy). CI Air Condiu`crri,
F-i,:iicilltion (iniorior non-sti -Lictur2l) 0 Electrical Alteration (not service change) L1 Gas Lighter [.7 Gas Log
I-1.,ndnq Unit L J Lawn Sprinkler El Mobile Home replacement 0 Roofing 0 Sewer Line 11 Photo-vollair.,
i Vanii1adoll-
afar Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified• provide nia
r-,:,.ctu rer)
;chiii,l to all ami;icable IjIfOnlSatjori on the application. incomplete applications will not be accepted.Data 3_1LPJL7 . . ... . .......
li?r office use only
Valueol'ConstructJon (labor, ri�.. ricil', m) . H.,
Job _"'�:ta "I'doli-ass; (1-apmred)
Fo c o___Ld
M 121- V1_
01 -tyOwnei-Name dress City/State ZIP Phone
3!
71
Address City/State - P
� 41N. fc- Cz ?14,
Address city/state Zip P I I o
Ovrn & to RAY
i CijitbacLol-CiLy of Ft. Collins Sales Tax # Are you paying taxes here or by report? L3 I ler-2 1*-
roquimc1tv E?// co�76-.ktOrs. Are you paying with your ti-ust account? VYes -'-I N':1
js 6lis a lasidellual 01. colprilercial,project? e(ResidenUal 0 Commerdal
Condo/townhome (single family attached) [I UUPIOX
V 0'Single Family Detached 1i
0 multifamily (apartment) 0 Garage
if commercial, is it: 0 Bank El Bar El Church El Hotel/Motel El Medical office 0 Office Ej Rei-ail
0 Restaurant El other (explain)--------_
uildinig S0 yeal's Of age or more? D Yes 0 No lfyes, you mayneed to cof7t,7cti-115toricProsetv-7rioij
-
derno"oon perms-t , what year was the building consti-ucted7
to.197!7, you mil need anasbestos assessmenttosubmit with U715applfcad0n.
-4)Lion of vvorl:
%- Ali ct
-VA
-AL.
if!,mi, 5orinkler/backflow pi-cventer, must list licensed plumber. dfirst-Urne A/C, nIL15L .,_ansed electrician.
P1 Lill ber—_ Mechanical Roofer Uthz::
-ate that the above information is complete Lhal. I have read this application and state Le and Corio,.L. -grcro i,-.
v4i'JI all requirenienits contained herein and city ordinances and State IaWS regulating building construction. .1 c;
u;,,L:4; 7-thas be=n paid and issued.
Var, 4o 3 J17
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