HomeMy WebLinkAbout3926 Gardenwall Ct - Applications/Water Heater - 03/01/2012MAR/01/2012/THU 09:18 AM DELTA MECHANICAL —AZ FAX No.480-898-0005 P.004/004
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Ale,
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Fort Collins
3D39'Y
Planning, Development & Transpi
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). ❑ Ai{ ❑ Jo
Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ C 1
❑ Heating Unit ❑ Lawn Sprinkler Cl Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑Photo- I
❑ Ventilation i(Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make,
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be acc9pee,
Application # f2i M" f i ✓ Date) 14 14 2
For office use only
Job Site Address (required)
Val of construction (labor, materials, profit)
39 Z(o Qr&,Y_A \A.V)A Ck
Property Owner Name Address
19_\A - 26
City/State
4 �Or�CA�AS
Zip Phone
CD 805Ly ?TO-#
o ¢cur 6wr�tIbVtill(,(,
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Applicant NNe Address
City/State
Zip Phone
aYW loMk.(S (3@vQsbelo"
&b-69A-5a-l3
Address City/State
6110t 1g�Rd.
L�Otjl�,&Ctlarjl[QLIOLh�
Zip Phone
85206
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Where ❑ Report
&'J� ❑ No
salesErmqulredbya//mncacras
wnb
Are you paying with your trust account? s
N1R(A(3"b
Is this a residential or commercial project? XResldentlai .❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: IJ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes c Ifyes, you may need to contacfHlstorfcPmservatlon
If this Is for a demolition permit, what year was th6 building constructed?
If prior to 1Y75, you will need an asbestos assessment to submit with bhls application.
Description of work
UP
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of ct Collins l/cense ,:
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. ,_11
Applicant: `+1
Dar( l�ji,i /I
Print Name: ""t 1
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