HomeMy WebLinkAbout1901 Bronson St - Applications/Water Heater - 10/22/2013OCT/22/2013/TUE 04:06 PM DELTA MECHANICAL -NV FAX No,702-369-9578 P.001/001
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation kVater Heater ❑ Water line ❑ 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 # <F7 150S-9g0 Date
For office use only
job Site Address (regcn )
Value of Constr
ion (labor, materials, profit)
P o rty Owner Name
i
Address
G l b y
City/State
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zip Phone
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A plicant-Name.
Address
city/State
Zip Phone
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Address
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City/State
Zip Phone
1352Cfocha
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155
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? VHere ❑ Report
Yes No
Sales tax n umber ids required by all connactors. Are you paying with your trust account? & ❑
orb \OKU
Is this a residential or commercial project? �Residentlal ❑ 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 ❑ Retail
❑ Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes 'No If yes, you may need to contactHistarlcPreservat/on
If this Is for a demolition permit, what year was the building constructed?
if pnor to 1975, you will deed an asbestos assessment to submit with this application,
Description of work �y a;+r R- h2LL R-
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the companyname orOVofFt Collins license
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.
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Applicant. r
a Fo ..0
riot Name ' - ` Signature nature Date
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