HomeMy WebLinkAbout725 S Taft Hill Rd - Applications/Water Heater - 12/18/2013DEC/16/2013/MON 12:02 PM DELTA MECHANICAL —NV FAX No,702-369-9578
P. 009/013
Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
Fort Collins 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
17 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ID Ventilation VWater Heater ❑ Water Lino ❑ 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 # &130(.o525- Date � C• I�•2013
For o>iiv use only
Sob Site Address rrequired) Value of Construction (labor, materials, profit)
-42 S TCnI1�12 -
Property Owner Name Address City/State ((��ZIP Phone
80 Qa 3
A plicant Nye. Address City/State Zip Phone
Y IOSame(2 low/ �q�-5a�►3
ontract
toI c
Address City/State Zip Phone
I (p�e15vRd. ecsa �� 852C6 1�12, 5a�3
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Hera ❑ Report
5e1es faxnu be lsrequlredbyall contractors. Are you paying with your trust account? Ca 1(S n No
'�f"fo O �RuSt
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Sank ❑ Bar ❑ Church .0 Hotel/Motel CI Medical office ❑ Office 17 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Oo Ifyes, you may need to contdctHistoricPreservation
If this is for a demolition permit, what year was th6 building constructed?
ifprlor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinklerlbackfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors,. L6t the company name or Gfy of Ft Collins license .t
Zectrician . 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 constructon, I know that a
permit is not valid until it has been paid and Issued. ,.
Applicant; � r�l f l 0 rr/,j
Print Name. ✓`^ �'i 1 "�� �` Sig