HomeMy WebLinkAbout4501 Boardwalk Dr - Applications/Water Heater - 08/26/2013AUG/26/2013/MON 03:59 PM DELTA MECHANICAL -NV FAX No,702-369-9578 P,003/003
City of
Fit C011ins
Planning, Development & Transportation
281 N. College Ave P.O, Box 5.80
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
p Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation IkVater Heater ❑ Water Line Cl 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 office use only
ita ddre�s/s required)
`
Value of Co stru
'on (labor, materials, profit)
f !L�V1
14- 7
pe BOO er Ala aJN)J
4
dress
ly
ty/Stake
tt�t
' Zip Phone
lZip
Applicant Na e
Add��rAddressCity/Statetee
Phone
Y6 oMW
:Samea&bpi or•r
6-(q� 5a�►3
o tra
(nor
Address
I�Ef5qRd.
City/State
��
Zip Phone
36Mb XL-(�l�-6,+
1
115�
�cSG
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? VHere ❑ Report
Sales to be Is requiredby an contraabm Are you paying with your trust account? 111`1es ❑ No
2i tJ ORLA(S'E
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church .❑ Hotel/Motel ❑ Medical office ❑ Office Cl Retail
❑ Restaurant IJ Other (explain)
Is this building 58 years of age or more? ❑ Yes tLlNo Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
w
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: ii5t the company name or City of Ft Collins Ikense AV
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 ordlnances.and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant, rJl
Print Name: L 1 I "�
LJ_