HomeMy WebLinkAbout3755 Kentford Rd - Applications/Water Heater - 07/13/2012JUL/13/2012/FRI 03:49 PM DELTA MECHANICAL —NV FAX No,702-369-9578 P.006
Cityof vv 1, lC� Planning, Development & Transportation
Fort
Collins281 N. College Ave P.O. Box 580
4 CFort 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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic
❑ V mulation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application, Incomplete pplications will not be accepted. a I,
Application # Dk-,) L Q apI Dat la
For office use only
Job Site Address rwhe) I
Valve of Construction (labor, materials, profit)
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Address
City/state Zip Phone
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A plicantMeAddress
City/State Zip phone
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Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ere 0 Report
salesta. a berisregw;mdbya/lcontractors.
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Are you paying with your trust account? �es 11 No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
M Restaurant ❑ Other (explain
Is this building 50 years of age or more? ❑ Yes "'No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th+; building constructed?
Ifprior to 1975, you W11 need an asbestos assessment to submit with this application.
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Listthe company nameorCityofFtCollins license .0
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; ��rf1 —O y-y5
Print Name: l� i i`y "�
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