HomeMy WebLinkAbout400 Jackson Ave - Applications/Water Heater - 02/06/2018t
Plan ipjl) 'ant u diansportatiou
i 3 281 N College Ave P.O. 61i( 53t1
Fort Collins;C0805 4
Phone 970 41ii-27 Fax 224-6134
l"E;s applicatipn is to be usedlto apply fio tlta follo>ivtng !?,Omits only (c#iecic all at apply). 0 Air Conclitioning
US moUSoii (int,dor not? strtac ural) ❑ Electrical Aiieration (not seNiae change) ❑ as Light0Gas Log y
! I Naating Unit Q Lawn Sppliker ❑ Moblle l lorpe replacement ❑Roofing ❑Set r 1 the Qer Photo-voltai6
t' i VantiTaUon; 'titer Heater l Water Line. 11 WOO. lPeilef Stov-e (must p, EPA de ified, prbvidr? make. modal : ,iu
rtanurpttirer)
GOIII Pte'te zil applicable Info ation do the appUcat.lon: Incomplgt appllcatio.ns !i11 riot be accepted.,
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' . Address City/State . z(p' Phone
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C�nliacor Cii of Ft; Collins Sal` ax Al a you payuig taxed het, or y report? ❑ F1eraItcrol i!
4 = a pte z p'. n itft qurh�' account7:'t Yes Flo
.i �; sit nunz' &Ql r ulredhyall aintYdc[4rs YT
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]s diis;d ,sirlentiaf or < `ntei dai �pCo]ect7 denial ❑Commercial
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Ii l eyd'ehiial, is It, " wit; Fhome (single family atta . ed) Cl Uupl'zx
❑ Mulhfa'mi (apar[merifi) [7 Gettig,
iP commerclalr is it ❑Bank ❑I[ier Church Ci Hotel/Idotel ❑Medical ofitce Id ifce iJ itetaii I.
❑ Restauren+tt 0 Other,`(�xpialn) —
1 ,this I,n.li)dln9 SO *%eags o; age r more? tT7 Yes i7 No IfyeSr youmaynge. to con fllstorlcPreszrYaGon _
is for a derAbl�ilon perrni whatyear.,Vw the pudding constructed?
!,'wrartu 1975, y'ou Ivll/nee"dab �sGesfosassessn�entfo$ri6lnrt wrdi fixsappl/cdryon • `_^ t
_ _ _ j_. •• JR�\ 1
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Description ofwork.
IF lawn spnnkler/badcflow prevenr, must list Ifcensed pTum6er, If first-time A/G; fiust t(stlic, Lsed elei6lcian. !
j Sul. cona•actc; iisttlla nj bnl tname01-OYbfFt611lnslicense;' 1
Piumbe� Mechanical___-- Roorer _ _ . Other
tI.•„ I,y acknowledge that I have read this application and state That the above InforritaLion Is c mpieh and mnect i agree ro
,`r ,n ]s sall I re 6rits ot valid d until it has �i�eeniga d and issued.
inanoes and slate laws regulating builing mnsUtictlon, I lu:ow that a
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;:;�p;:cal�t: �_ uate i
' Print Na^:cL /trn �C'l11 l't G C��}^t, -signature _ ciw ...V..�^'. ^ .. '
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