HomeMy WebLinkAbout944 W MOUNTAIN AVE - APPLICATIONS - 3/12/2015I City, of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort 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 ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 19 Water Heater ❑ Water Line O 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 # 2)150 1 &15 Date 3/12/15
For office use aq/y
Job Site Address (required)
Value of Construction (labor, materials, profit)
944 w Mountain Ave
$1,224.47
eroperry uwner ivame
Aooress City/State Zip
Phone
Ali n;,.".. N44 W T•T.".., i, I p.1 i, i, ,rpv IIL Ct-1111A� OV^.52L
7/U--1_L6-1/239
Applicant Name
Address Clty/State Zip
Phone
John Santos 6056
E Baseline Rd Mesa AZ 85206
866-692-5273
Contractor
Address City/State Zip
Phone
Co Delta Mechanical 6056
E Baseline Rd Mes Az 85206
866-6 2-527
Contractor City of Ft, Collins Sales Tax #
Are you paying taxes here or by report?
® Here ❑ Report
SaiesraxnumberIsrequnennyall contracmrs
Are you paying with your trust account?
isl Yes u No
�°Oa'
Credit or Trust
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 ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? []Yes ONQ If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
!r pnor m .eyro, you wni neea an 7soebTos assessmenr ro suomir wim rnis applicaaon.
Description of work Replace 50 gallon gas water heater
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Cu6ce NCfoeke ram. LJIt rho �-7v
Electrlclan 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. I
Applicant:
Print Name: John Santos Signature Date. 3 /12/15
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5000-868-OP 'ON Xbd ZH-1V'0INVH9HN VIIN Wd 00: [0 M/SIOZ/ZI/M