HomeMy WebLinkAbout2725 Antelope Rd - Applications/Water Heater - 05/06/2014APR/15/2014/TUE 09:47 AM Delta Mechanical Inc FAX No.866-692-5275 P.009
City of
/ Fort S
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 ❑ Gas Log
C1 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic
0 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 applications will not be accepted.
Application # S 140 21 q 2. Date DS, OLI. 20I4
For oBlre use only
job Site Add 6reqyIred) Value of Constructl n (labor, materials, profit)
2'12S �ntQIo e a 85 . l o1T.00
Property Owner Name Address City/sIfte Zip Phone
m Q Z
A plicant Na a Address City/State Zip Phone
rou o kCS
0
tra Address City/State Zip Phone
%t- l" lnvRcl.
47- 362CIo
Q]i izi II66A
Contractor City of Ft. Collins Sales Tax # Are you paying taxeg here or by report? ere ❑ Report
Sales ray l r6 mgzfffedby 811conoactws. Are you paying with your trust account? O fires ❑ No
Is this a residential or commercial project? XResidentiall ❑ Commerdal
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
T
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?ClYes No Ffyes, you may need to contactHlsfm•1cPreseirvation
If this is for a demolition permit what year was building constructed?
j.
Yprior to 1971, 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-time NC, must list licensed electrician.
Subcontractors: G'st the company forme or 0y of Ft Collins htense fi
ElecUklan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above infonnalton 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: TPar4l�V,r-t7
Print Name:_ 1 v I"+ ��