HomeMy WebLinkAbout1916 W Elizabeth St - Applications/Water Heater - 08/08/2012AUG/08/2012/WED 11:49 AM DELTA MECHANICAL —NV FAX No,702-369-9578
P. 004
c3l'k306
fit of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort CoRi s Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) LI Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation VWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). ,
Complete all applicable Information on the application. Incomplete ahplications will not be accepted.
Application # 60
Tj�c�2a Date_
For office use only
Sob Site Address wire
Value of Construction (labor, materials, profit)
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operty Own r
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Address
Izip
6
City/State Phone b
06
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Applicantfolm
Address
City/state ZIP Phone
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6-(oq2,-5273
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Address �S` I,Ov 0. City/State Q zip / Phone
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# 155
66Cj 47-
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
sales tax number is raqulmd by all mn/racfom.
Are you paying with your trust account? [3 des ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) A Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th building constructed?
If ptior to 1975, you will need an asbestos assessment to submit with this appllcation.
Description of work Reulla(-_P) VV a"7il-,R- hea-itri
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*If lawn sprin /backilow preven r must list iicen ed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins 1/tense 0
Electrician Plumber Mechanical 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 building construction. I know that a
permit is not valid until it has been paid and issued,
Applicant,�-l� }}(�� r
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Print Name: " SignatureN/aNl Date
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