HomeMy WebLinkAbout3914 Grand Canyon St - Applications/Water Heater - 04/18/2014APR/15/2014/TUE 09:46 AM Delta Mechanical Inc FAX No,866-692-5275 P,007
City of
,�F�ort Collins
Planning, Development & Transportation
281 N. College Ave P.0, Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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) El Gas Lighter ❑'Gas Log
❑ Heating Unit Q Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
CI 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 # B 14D l boa Rate '1
far oirice use only
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Job Site Address (re uired)
Value of Construction (labor, materials, profit)
391Gran . In ►e)
2 (O's - b0
Property Owner Name Address
City%State Zip Phone
c a ►IA Iv
363-13 -- bzo 3
A plicant Nye Address
City/State Zip Phone
I r lol�'G.kCS Samea6bPjoV'j
SE6-�92i-5a73
Address CV/State Zip Phone
r (p0�%E pasetl5'sv(ld, �� $52% bq31.5373
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here Ci Report
Isles ❑
Sees W numbs � mqulredby air ronaactn r.
Are you paying with your trust account? No
Is this a residential or commercial project? X Residential ❑ Commerdal
If residential, is it: ❑ single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar p Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant 0 Other (exRi�lain)
Is this building 50 years of age or more? ❑ Yeso If yes, you may need to contact HlstoricPreservation
If this is for a demolition permit, what year was building constructed?
If prior to 1975, you will need an asbestos assessment to submit wIG4 this application.
Description of work
*If lawn sprinkler/backilow, preventer, must list licensed plumber, If first-time A/C, must list licensed electrician,
Subcontractors) List the company name or City of Ft Collins license #
Electftan Plumber. Mechanical Roofer Other
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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, ,
Applicants arC1�(�y-yj l
Print Name:
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