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Home My WebLink About820 Merganser Dr - Applications/Water Heater - 05/24/2016 (2)May 1516 08:24p Ellmann Service Co 9702233324 p.1 Planning, Devetapment &TransPortation Z81 N. College Ave P.O. Box 580 F& .C€ lbns For< Coinns, c0 sos24 Phone 970-416-2740 Fax 22+6134 OVER-THE-COUNTE PERMITS ONLY This application is to be usad.to apply for the following permfis only (check all that apply). 0 Air Conditioning 13 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Ci Gas Log ❑ Heating unit ❑ Lawn Sprinkler Cl Mobile Home replacement ❑ Rousing CI Sewer Lme O.Photo-voltaic ❑ Ventilation' ❑ Water Heater C1 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable Information on the application. Incomplete applicatloris will not he accepted. Application # 15 < <00;?' 5 b Date S Fnrnfnee use only 41,9t — ]vh Sites Address (2quiffld) Value of Construction (tabor, materials, profit) �t L� AddressC 5-bJZ GtY/5iatep �.e s>r Phone�j 'J'Ci Applicant Name Address city/state bop Phone ..% r�r�+-�.? = G-+ v ��x�.¢.s :r ' • l �'�-'� �� ij'r.>! � •— � �%'Gf � .� y ��ri �� —mil! 3.� cort Vcior Lic # Address Zip p1 sun ie r� ��,�-tl�r�' - Sri .-:!c-•�. �'G� .. r� =%/ l � ��'+ir-�F 5/?..�•,z S,��:r S/�7�� Contractor City of Ft. Collins Sales Tax 3l� cc J!- . Are you paying taxes here or by report?' C! Here OMport Sales twnufabwisraquiredhyaffeartbachws Are you paying i0ith your trust account? )'Yes ❑ No Is this a residential or oornmerdal project? ZResidentlal ❑ Commercial If residential, is It: i Single Family Detached ❑ Condo(townhome (single family attached) ❑ Duplex ❑ MulbTamlly (apartment) Cf Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ offlce ❑ Retail ❑ .Restaurant 0.0ther (explain) - is this buiiing 50 years of age or more? la Yes ©No rfyes, you mayneea to Cl7n ctfilstollcplasawffOI7 If �iis is for a demolition permit; what year was the building constructed? rfpr'ar ib 1975, joy wl11 creed an asbestos assessment to submit• WM tfiis apphication Description of: work - - --- --- - If lawn sprinklerlbackiow praventer, must list lleensed plumber. If first-time AJC, must list Irr_ensed elec- - hicta- Subcontractors: Lisithe companynarre orGiyafFrCalrnsticar7sa Etacb ician Plumber - Mechanical Roofer Other I hereby acknowledge that have read this application and state that the above irdormation Is complete and correct. I agree to comply with all requirements contained herein and city ordinances and State laws regulating building consbvction. I know that a permit is not valid until it has been paid and issued. Applicant: _ ��...� Prink Iyame: �Yd��aiS �F �,.sign 'r Date S L4