HomeMy WebLinkAbout1225 W Prospect Rd - Applications/Water Heater - 05/01/2014APR/28/2014/MON 02;54 PM Delta Mechanical Inc
City of
Fort Collins
FAX No.866-692-5275
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
P. 004
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
❑ Heating Unit Q Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Water 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 #� , 5140 210:1 Date M &v 0( . 2014
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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P perty Owner Name
Address
City/State Zip Phone
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Address
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Clty/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 of by report? VHere ❑ Report
sales tr� nu�GGs nWh ed by as contractors.
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Are you paying with your trust account? l331es ❑'No
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Is this a residential or commercial project? gResidential ❑ 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
M Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th building constructed?
If prior 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 A/C, must list licensed electrician.
subcontractors: List the company name or City of H 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. -,
Applicant: I—{''
Print Name:` " r�' I ' ' Signature Data ^ ~�
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