HomeMy WebLinkAbout818 BREAKWATER DR - APPLICATIONS - 3/20/2013'Mar.20. 2013 2:35PM
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City of -
Fart Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply forthe following permits only (check all that apply), Id Air Conditioning
,'Demolition (interlornon-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter U Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line U Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Date
For of/Ice use only
Is this a residential or co merclal project? I1KResidentlal ❑ Commercial
If residential, Is It: )d Single Family Detached F1 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerclal, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office D Office ❑ Retail
❑ Restaurant ❑ Other (explain) , _ __
Is this building 50 yea rs of age or more? l7 Yes j No If yes, you mayneed tom act Historic mservatlon
If this is for a demolition permit, what year was the building conshvcted? f��__
Ifprb,r to 197S,, you wi//need an asbestos assessment to submit with th/s application.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors, Llst the company name or aty of Ft Coll/ns license ,v
Roofer Other
I hereby acknowledge that I have read this application and state that the above Information Is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating bullding construction. I know that a
permit is not valid until It has been paid and Issued.
Applicant: , V� �' (�/�/I ! �Q IJ
Print Name: �Irl "WG_Signature_ `G1 Date 5 l
1 of 3/20/2013 10:42 AM