HomeMy WebLinkAbout2301 Mathews St - Applications/Water Heater - 05/21/2015MAY/20/2015/WED 04:38 PM DELTA MECHANICAL —AZ PAX No,480-898-0005
P. 003/004
aD City/ of Planning, Development & Transportation
T 281 N. College Ave P.O. Box 580
r Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
N
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 Q Gas Log
❑ Heating Unit Q Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing CI Sewer Line ❑ Photo -voltaic
❑ Ventilation 9 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 # :al SO Date . Z 11
For office use only I I
lob Site Address (regwnad) Value of Construction (labor, materials, profit)
o 96626 2 11%64'1
Property Owner Name Address City/State Zip Phone
�510,as 46vc gin-qq coly
Applicant Name Address City/State Zip Phone
tome at) 1 o vi
Contractor Address City/State Zip Phone
Colorado �.Ik4 G l�r►L'r �d �' S� fl gS2oGv
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by reporC? Here ❑ Report
Swestax nu. p�rig r,/,�edbyal/cvnaectrors Are you paying with your trust account? eyes ❑ No
Is this a residential or commercial project? 16 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: 13 Bank 13 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑Other (explaiy?
Is this building 50 years of age or more? 4 Yes �'No lfyes, you mayneed to contact N/staricP�seivation
If this Is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestas.assessment to submit w/th this appllcat/on.
Description of work
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*rf lawn sprinkler%backtiow preventer, must list licensed plumber. Ir first-time A/C, must list licensed electrician.
Subcontractors: Gist the companynameoratyofFtCollins11banse#
Electridan_ Plumber , Mechanlral Roofer. Other
I hereby acknowledge that I have read this application and state that the above information is Complete and Correa, 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 r3�
Name: �J'I Signature Date ��