HomeMy WebLinkAbout6920 Barbuda Dr - Applications/Water Heater - 04/10/2014MAR/26/2014/WED 05:48 PM Delta Mechanical Inc
FAX No.866-692-5275
P. 006
E;
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) d Gas Lighter ❑ Gas Log
❑ Heating Unit Cl Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
C1 Ventilation VWater 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 # 3 1 q0l 4 b 3 Date K1/0 Ll
For ofte use only
job Site Address (required)
Value of Construction (labor, materials, profit)
C7
Property Owner Name
Address
City/State Zip Phone
1 rcA
G1�O 942,9
A plicantTNe
Address
City/state Zip Phone
Y 4Zi k.CS
r a&be. oN
b' (og2,-52-13
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Address my/state zip Phone
bu%E.DPS 151Ze)0. Az;35Z0(o a&bgA-5a-13
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GcSA
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ere Q Report
-Mes r nupw1rmg0vdbyal 0ntractors
Are you. paying with your trust account? ❑ No
Is this a residential or commercial project? ]Residential El Commercial
If residential, is it: ❑ Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Cl Yes Oo Ifyes, you may need to contact Mist0cPfeservatlon
If this is for a demolition permit, what year was thbuilding constructed?
If prior to 1975, you will need an asbestos assessment to subm/t with this appilCa#on.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractorsi List the company name or i7ty of Ft Collins /kense #
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: Curia I nKm U
Print Name: 1 �Signature Date