HomeMy WebLinkAbout805 Parkview Dr - Applications/Water Heater - 11/24/2014NOV/24/2014/MON 09:47 AM DELTA MECHANICAL —AZ FAX No.480-898-0005
P. 002
City of Planning, Development & Transportation
� M} (� + • 281 N. College Ave P.O. Box 580
�6e L � Chins Fort Collins, CO 8o524
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 J2 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation lif 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 # ' ` 51 44 21 29 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
105 c vi 25 170•`II
Property Owner Name Address city/state Zip Phone
ba In vt 6aau as a vt o- 3 - y .
Applicant Name Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Sales tarMi d byattconbactors
Address City/State Zip Phone
�Ilnl CIA a P5 , !&A f
Are you paying taxes here or by report?
Are you paying with your trust account?
Is this a residential or commercial project? ?T 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 ❑ Medical office ❑ Office El Retail
❑ Restaurant ❑ Other (explalrA
Is this building SO years of ape or more? ❑Yes !Q No T iss, you may need to contactHlstonc Presetvatlon
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
❑ Report
❑ No
Description of work qo gallov,a5he
Nsl0{h
0
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: list the company name or CRy of Collins 11ce17se ig
EJectndan 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: ,I
Print Name: �J I Signature Date