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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 04/05/2016Apr 2516 06:46p Ellmann Service Co 9702233324 p.3 Planningr Develapment &Transportation City, of 281 N. College Ave P.Q. Box 580 Flirt Collins Fort Collins, CO 8D524 Phone 97�i 6-2740 Fax Z246134 I., R-THE-COUNTER PERMITS ONLY This application is to ba aged 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 0 Heating Unit 17 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roeling ❑ Sewer Line Cl Photo -voltaic ❑ Ventilation oVater Heater 0 Water line D WoodlPellet Sieve (must be EPA certified, provide make, model and manAoturer). Complete all applicable Information on the application. Incomplete epPlioa i ns IN11 not be accepted. •E21 Ud 2 Date � � raroicce use only fob 5ite.Address (mgrffred) Value of Construction (iaWr, materials, profit) 2ae• I Applicant Name C Slat �ke�� PhonegF? A�cl�dress�S? %-bTC.. 't'1 31t - ,,, ,A " � j{I ' � 5 Address Contractor Uc # I Address Citylsiate zip. Phone cVstate Zip Phone Contractor City of Ft Collins Sales Tax 0 3� «J— Are you paying taxes here or by report? © Here ($Report Saks laxaumberlstagtd2dbyollcoRdactor;, Are you paying with your trust account? W. 0 No is this a residential or commercial project? 1 Resldenlial. ❑ Commerdal If residential, is it: 5f Single Family Detached ❑ condo/townhome (single family a; ached) ❑ Duplex ❑ Multifamily (apartment) Cl Garage if commercial, is it: ❑ Bank ❑ Bar O Church CI HotBVMotel ❑ Medl I office ❑ Olfiee ❑ Retail M Restaurant.. [3Other.(explain) is this building 50 years of age or more? ❑ Yes i3 No TryeS yell Mrayl7eedtoCUnzactH[5WIcPresermi on If this is for a. demolition permit, what year was the building constvcbadI7 Ypifor to 1975, yore U411 Mead an asbastosassessmenf to submit rvrth &5 applicah'on Description of work *If lawn sprinklerlbackRow preventer, must list licensed plumper. If first time AJC, must list licensed electridan. Subcontrackom: LA-t the company name or Gry or rr W,J 75 /fcense . Elecbide l Plumber - r4echan9mi Poorer Other I hereby acknowledge bhat I have read this application and state that :he above information is complete and correct I agree to comply rritn all requirements contained herein and city ordinances and skate laws regulating building consbuciion. F know that a permit is not valid until it t = been paid and issued. Applicant __.....� .,+ Arinf Name:dr»'W.S G�1.o. SiSnatd� -'~' pate r