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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 06/04/2016Jul 0416 09:39p Ellmann Service Cc 9702233324 p.1 Planning, Development VLTransportatlon City of 281 N. College Ave P.O. Box 58D Fort Collins, CO $0524, Phone 970-416-2740 Fax 2246134 OVER-THE-COUNTER PERi4 ffS ONLY This applica en is to be used to apply for the following permits only (check all that apply). O Air Conditioning t2 Demorldon (interior non-structuraf) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log E7 Heating Unit ❑ Lawn Sprinider 0 Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo -voltaic 0 Ventilation ❑ Water Heater 0 Water Line ❑ WoodlPeltet Stove (must be EPA certified, provide snake, model and manufacturer). Complete all applicable information on the appilca#ion. Incomplete applications willill not be accepted. Application # � d tom � � � O Date Far crime use only lob Site Address t &red) Value of Construction (tabor, rnatmtals, profit) )V-)A am 120:- .rs- P .V� L Address?57j'j�ls Phoney�J t7 u��a�uw Applicant `` Name Address city/State - � . zap M .{.�a�� �� fl�'i.� •t V—Y f!t JLiRI•_�IL \/ f i� f ��17 �% 1+�ti r �J �Pho}n�e ! C,V �w�J'/I j Cco'rritracwr Lit # Alddrt_ss City/state . Zips gti+oi�e Contractor City of Ft:. Collin Sales Tax # 3k-:2&;jF— Are you paying taxes here or by report? ❑ Here Orkeport sa/estaxnu�r�aresregiare�byaflcantrariar� Are .you paying with'yourirttst:aecounc? R`Yes C! No is this a residential or er rnmerdal project? Mesldentlai ❑ Commerdal if residential, Is it: 0-Single Family Detached ❑ Cmdoftownhome (single family attached) C7 Duplex ❑ Multifamily (apartment) 0 Garage if commerdal, is it: 13 Bank- Q Bar 0 Church 0 Hoteljhiotel 0 Medical office ❑ Office 0 Retall ©-Restaurant . .. D.Ot her (explain) Is thus building so years of age or more? D Yes L7 No Ifyes, yvu mayneed eb mnfactXlstarirPreserrdiion If this is for a. demolition permit, what year was the building. constructed?. FfPrior you wi/l need an asbestos assessment fo SUbmlt with this appllcadon. Description of work a lawu wrinmerjoacrmow preventer, must list licensed plumber. If first-time A/C, must 1cst rcensed electridan- Subaontractarm Lle eC0MAWynemeoranyyrRCo//lnslicensa Eaclridan Plumber-----____::__+Ke�7anttst Roofer--�,, Other I hereby acknowledge that I have read this application and state. that the above 1111brmabon 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 perrnit 5s not valid until it has been paid and Issued. rr Applicant. Print Nan3e:l- ~�