HomeMy WebLinkAbout2127 Copper Creek Dr - Applications/Water Heater - 03/15/2018PlIalnnillm-, Devellopment & Tram
N. College Ave P.O. Box 580
1?�j Fort Collins, CO 80524
fir" • Phone 970-410-2740 Fax 224-6134
0—THEU PEAMM ONLY
This application is to be used to apply for the following penT ats only (check all that apply). O Air Conditioning
❑ Demolition (interior non-strucburat) ❑ Becirical Alteration (not service change) Q Gas Lighter ❑ Gas Log
❑ Healing UnitLawn Sprinkler ❑ Mobile Home replacement ❑ Rooting ❑ sewer Line ❑ Photo -voltaic
❑ Ventilation iflhaier Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA ceriafred, provide make, model and
manufacturer]
Complete all appOcable WfonTiertion on the app&cataan. incompfeFe applications wig not be accepted.
Application # e ( $0 ( %sr-j Date 3- 7., l 9
For O lm use only
Job Sae Addmss CreF•ire�
Value af, Const'ruciim- galxu, materials.
profit) 1
?-1.;t% C�- ec.Dr� 1070
operty owner Nanie
'a.�
Address E City/State -W � � I i Tip
�65�g
Phone %v
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Appficamt Name
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Address : City/StateTip
5XI V\jt tshif-Ltd- C-7ailC,l-d -N -lS&43
Phone '-Pe
l Contractor
Address. City/State Zip
Phone
i
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
ctni tax numbEr 6 reqLdred by all mar-,.
Are you paying with your trust account? ❑ Yes
❑ No
is this a residential or commercial prajmt? ❑ Residential ❑ Commendai
if residential, is it kSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
CI Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Sank ❑ Bar ❑ Church EI Hotel/Motel ❑ Medical Ofnce ❑ Office ❑ Retail
0 Re5lawant ❑ Other (explain)
is this buikdmg SO years eF age or more? ❑ Yes C3 No 1-ryes, you may need to contact Hisini Pre on
If this Is for a 3emeWdon permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
[?ascription of work `I
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*If lawn sprblder/baddlow preventer, must list lice- sed plumbs. If first -lima A/C, must list licensed electrician
,;tbwrraseGors: List the company name or City or Ft Collins ficense T
l ft0ILLIG Me Rooter Other
11 c eby advnowfedge that I hove read finis appliotion and state that the above irdrarrration is complete and conect I agree to
comply each all requirements contained herein and oty ordinances and siEte taws regulating building cOnstrudion F know that a
perw't is not vaBd rmtn it has trees paid and issued.
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Applicant:
Prim Name: i boil I `�i i Signature �l /