HomeMy WebLinkAbout2433 Poplar Dr - Applications/Water Heater - 02/13/2015FEB/12/2015/THU 10:28 AM DELTA MECHANICAL —AZ FAX No,480-898-0005
P. 002
40 City of Planning, Development & Transportation
Collins281 N. College Ave P.O. Box 580
r F6rt CFort Collins, CO 80524
`�,-- Phone 970-416-2740 Fax 224-6134
O
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Q Air Conditioning
❑ Demolition (interior non-structural) 13 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit P Lawn Sprinkler ❑ Mobile Home replacement d Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 1W Water Heater d Water Line Cl 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 # TJ 16-000N � Date • 1 J
For office use only
Job Site Address (requlmd) Value of Construction (labor, materials, profit)
Iqn C.011In lj ?
Property Owner Noftame Address City/State Zip Phone
d Q S a c, 1 — c
Applicant Name Address City/State Zip Phone
contractor City of Ft. Collins Sales Tax #
Sales fax nj14?tar.2yggVed by all cantractom
Address City/state Zip Phone
" 1
Are you paying taxes here or by report? Ef Here ❑ Report
Are you paying with your trust account? &'Yes ❑ No
Is this a residential or commercial project? 'Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai )
Is this building 50 years of ago or more? ❑ Yor OrNo Ifye ; ynu mayneed M �vntact/�isticl� PiCscry t1on
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application,
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City 01,a Collins license #
Bectrician 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: (
Print Name 'J11 of Signature ..Lr r Date