HomeMy WebLinkAbout4357 Gemstone Ln - Applications/Water Heater - 12/18/2013DEC/16/2013/MON 12:01 PM DELTA MECHANICAL —NV FAX No,702-369-9578 P,008/013
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City of
Fort 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 for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interiornon-structural)❑ Flectrical Alteration (not service change) ❑ Gas Lighter El Gas Log
D Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation VWater Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete appllcatlons will not be accepted.
Application # S13n(05-2a Date J� (°,:1 • ��4?
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
Applicant Nye
Address
City/State Zip Phone
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Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here EI Report
sales to be /SiWurFdbyammnoacrors.
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Are you paying with your trust accounZes ❑ No
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Isthis a residential or commercial project? jf Residential ❑ Commercial
If residential, Is it' ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) D Garage
If commercial, is it: ❑ Bank G] Bar ❑ Church ,❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes �6o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was tht building constructed?
If prior to 1975 you will need an asbestos assessment to submit with this application,
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-dme A/C, must list licensed electrlclan.
Subcontractors: List the company name or City of At Collins license #
Electtian 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:
Print Name;_ I`� "` Sig