HomeMy WebLinkAbout3002 W Elizabeth St - Applications/Water Heater - 10/24/2014OCT/24/2014/FRI 12:43 PM DELTA MECHANICAL -AZ FAX No,480-898-0005
P. 001
City, of Planning, Development & Transportation
0 pp C 281 N. College Ave P.O. Box 580
r„r -Fort Col ins Fort Collins, CO 80524
Phone 970-416 2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
0 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
0 Ventilation SJ 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 # R)19 M l0�ob Date
For olAce use only
]ob Site Address (required) n Value of Construction (labor, materials, profit)
2 c% i alb 5�- 1 r7 6i, co frostl iff 108004t
PropeIV%
wner Name Address City/State Zip Phone
OW4,11 rSCArn o a6 at uM, •WCl , 4{ 1 pie
Applicant Name Address City/State Zip Phone
��f4QCo��ntracto11r Address city/stateJte Zip �1 t Phone
UO-0 Act 1 G 6 �110 A 1lIZ Faa V(p
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here Report
sa/esraxnu eiltobyallcontradors Are you paying with your trust account? I(Yes ❑ No
Is this a residential or commercial project? 16 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) 17 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church L3 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other(explai
Is this building 50 years Of age or more? ❑ Yes WNo If yes, you may need to cnntactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you w111 need an asbestos assessment to submit with this appliraffon.
Description of work
*If lawn sprinkler/backflow, preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List Me company name or City of Ft Collins /lens,, #
Electfdan Plumber Mechanloal 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: I �}
Print Name: �J 1 Signature Date �Q *14 /