HomeMy WebLinkAbout2203 Copper Creek Dr - Applications/Water Heater - 07/16/201308/02/2010 03:28
#0613 P.001 /001
City of riannm
281N,(
Phone 9
OVER-THE-COUNTER PEI
This application is to be used to apply for the following permits only
D Demolition (interior non-structural) ❑ Electrical Alteration (not service ,
❑ Heating Unit ❑ J.awn Sprinkler ❑ Mobile Home replacement ❑ Roo
❑ Ventilation "ater Heater ❑ Water Line ❑ Wood/Pellet Stove (mu:
manufacturer).
Complete all applicable information on the application. Incomplete
Application # 1303102 02 Date
Frroffice use only
Development & Transportation
=qe Ave P.O. Box, 580
C0 80524
16-2740 Fax 224-6134
MITS ONLY
:heck all that apply). ❑ Air Conditioning
ange) ❑ Gas Lighter ❑ Gas Log
ig ❑ Sewer Line ❑ Photo -voltaic
be EPA certified, provide make, model and
tions will not be accepted.
apt 00-11 ,
lob Site Ad(d�ress (required) Value of nstruction (labor, materials, profit)
n
Property Owner Name . Address
city/State
Zip
Phone
OM<
Applicant Name
Address
City/State
Zip
Phone
r p
c 1C0
05ato . a-70•ao
-Abel
Contractor— c # Address
city/State
Zip
Phone
Prijor
Sarnia
Contractor City of Ft ins Sales Tax #
Are you paying
es here or by report? ❑ HW
Report
Sales tar numbe-isreW/redbyall cmnha$om
Are you paying with
your trust account? 1114es
❑ No
Is this a residential or cpmmerdal project? Residential ❑ Commercial
If residential, is it~ Ingle Family Detached ❑ Condo/townhome (singly
❑ Multifamily (apartment) ❑ Garage
If commercial, is H-- ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 11 Yes ❑ No Ifyes, youinmyn
If this is for a demolition permit, what year was the building constructed? _
If prior to X975, you will need an asbestos assr nt to submit wiifi this IWO
Of
*If fawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C,
Subcontractors; List tle company name or GOO Of Collins 11M75B 0
Electrician Plumber-nap3p 1 Mechanical
I hereby acknowledge that I have read this application and state that the above ii
comply with all requirements contained herein and city ordinances and state laws
permit is not valid unbil it has been paid and issued,
Applicant.
Print Nam
family attached) ❑ Duplex
)Moe. D Office ❑ Retail
to contact H/storic Premmafron
list licensed electrician. ,
Roofer other
is complete and correct I agree to
building construction. I know that a
Date Lite ) 3