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HomeMy WebLinkAbout1707 Briargate Ct - Applications/Water Heater - 07/13/2012JUL/13/2012/FRI 03:48 PM DELTA MECHANICAL -NV FAX No,702-369-9578 P.003 City of Planning, Development & Transportation Fort�' Collins281 N. College Ave P.O. Box 580 CFort Collins, CO 80524 Phone 970-416-2740 Fax 224-624 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 El 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, Application # Q0 OC- For offlce use only Incomplete applications will not be accepted. Date c V � 0 1 a o I g Job Site Add �16 ss (required) a�ue of Constrrictio (labor, materials, profit) 1 aQ P pe Owner ame efA►'Aa Address t'W 5gii City/State Zip Phone " ay-v E6111(ij (605a(a. A pliiccant Na e�/ l/c I off W�U Address r3� aUbe—AoN City/State zip r QPhone ^7 opts ct e G t Address IOp51b E. brill se) 0. City/State zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report 5ale5 tax nu berisrequired byail contractom Are you paying with your trust account? Iles ❑ No . \J/)RU (3t Is this a residential or commercial project? Residential ❑ Commercial If residential, is it: El Single Family Detached ❑'Condo/townhome (single family attached) ❑ Duplex . ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar M Church ❑ Hotel/Motel © Medical office ❑ Office CI Retail ❑ Restaurant Q Other (explain) Is this building,50 years of age or more? ❑ Yes o ffyes, you may need to contact Historic Preservation If this is for a demolition permit, what year was tht building constructed? If prfor to 1975, you will need an asbestos assessment to submit with this application. of *If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: rrst the Company name or City of Ft 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: � r-I1 f l-ji U Print Narne: l"'I i - i�1 "t Signature , date Sb s