HomeMy WebLinkAbout4062 Kingsley Ct - Applications/Water Heater - 04/10/2014MAR/26/2014/WED 05:50 PM Delta Mechanical Inc FAX No,866-692-5275 P.012
Fort 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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ 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 # 5 N D 16 66 Date
For office use only
.Job Site Address (required) Value of Construction (labor, materials, profit)
,40
Property Owner Name Address Gty/State Zip Phone
t4bord t-
A m pliant Nye Address City/State Zip ne l Yn.l ! IO�Yz L(� '5a aSbelow Scb-(oqA-5a�;
v LOPot
ra Address City/State Zip Phone
r �a bo 11*nt)0. GdA �� 852C6 �F��12,-5�73
Contractor City of Ft. Collins Sales Tax # Are you paying taxeg•here or by report'? ere ❑ Report
SEEMS raycu�b�rb requrrecbyau mnaec Are -you-paying with your trust account? L� des 11 No
9 .,3 �Ru6t
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: D Bank ❑ Bar ❑ Church .❑ Hotel/Motel ❑ Medical office ❑ Offlce d Retail
Cl Restaurant El Other (explain)
Is this building 50 years of age or more? ❑ Yes �60 If yes, you may need to contact HistwlcPreseivation
If this is for a demolition permit, what year was th§ building constructed?
Ifprior to 1925; you will need an asbestos assessment to subm/t with this applkatdon.
Description of work
*If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; Gist the company name or Gly of R Collins license .f
Electldan 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.
1`I
Applicant:rL1
Print Name;