HomeMy WebLinkAbout4240 BREAKWATER CT - APPLICATIONS - 8/12/2014r .r ma oruree W �.tr @7u.aYa n
This application is to be used to apply -.for the foilovAng permits only (cheek all that apply). D Air Condltioning
0 Damoillion entarior non-structumQ 17 Eledbicai Aitersoon (notaervice change) O Gas LighW ❑ Cas Log
Cl Heating Unit ❑ Lawn Sprinkler D Mobba Home replacement )9 Roofing ❑ Sewer Line D Photo-vokalc
Q VenfiWon 0 Water Heater ❑'Abdur Lute ❑ %AioodRallet Stove (must be EPA certa'%d, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete application will not be accepted.
Application # 7)I4-0S287-. Dane
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Job Site Address (fegund)
Value of Construction (labor, maieftis, profit)
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Pruparty Owner Name Address
City/State Zip
Phone
APP11CMt ame Address,
City/state -7J'p
Phone q W -
A4 fable 1'.00£i = air W. fiA R CQ PTZ Ca $oSiaS
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Conbt3cto3 Address
iy/State zip
Phone
Contractor City of Ft Collins Shies Fax
Are you payhV taxes here or by report? i ijet a
Er Report
S�les6r�umberbreOWralbyayWA rakm
Are you paying with your trust account? PS
0140
Is this a resdentiai or commercial project? - if Pasidentfat 0 Commercial _
If residential, is it: 10 ShLgle Family Detached ❑ C ondo/t=nhome (9ngle family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commen:M6 is it ❑ Bank ❑ ear ❑ Church 0 Hofal/Mlotei Q Mledical office ❑ dfffm O Retail
0 Restaurant D Other (explain)
Ts this btlHding So years of age or morel? O Yes D No if ye4 j w may nwd m cwf3i t Hlsfnrfc &emwvatldrr
If this is fora demolition perjult;, whatyear was th%•building wnsbtieled3
JFp arm JAM you wl#need'?n ashas= astawneutfn submit vJb tlrl.9 4Wee lam
Descdptlon of work
00 Fawn sprinkler/tacidlow praventer, must IM lionised plumber. If first-time Afr, must an llaensed uJamdan.
8ubcantrastara: LlSt'llre crampanynamsorGiyaPRCblhhsllcense a _
Eledrrdhn - vlumbet hterhanl®t Roofer OVIer,
I hereby aclamwiedge tha t I have reed this application and state that the above Infbrrealion W carVeteand eornul I sgrea tb
comply with all requirements contained herein and city ordinances and state laws regulating budding construction. I knowthat a
permit is notvattd until it has been paid and issued.