HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 06/12/2016Jul 0416 09:39p Ellmann Service Cc
9702233324 p.2
rt Collins
Planning, Development &Transportallon
281 tV. College Ave P.O. BOX 58D
Fort Cabins, CO 8os24.
Phone 970-416 2740 .Fax 224-6134 .
d iwER-THE-COL TER PERMITS ON1 Y
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 dhangs) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ .
Rooting iJ Sewer Line Ci Photo-voliaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Woodipellet Stove.(must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application• Incomplete applications will not be accepted.
Appiicafion # kbO�v�5 Date A l
For office use only
Job Site Address (regulred)
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Valve of Construction flabor, materials, profit)
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Applicant Name Address
City/State Tip
Phone
Contractor Uc Address
CIN5 ate Zip
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25_� if.tiL6r+r ly( =l15
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Contractor aty of FL Collins Sales Tax # .3Yr2oJ-- Are you paying taxes here or by report? ❑ Here OrReport
sales bxnwmbarlsraquirceby0conambs
Are you paying vvlth your trust account? jgrYes ❑ No
Ls this a residential.or commercial project OResidentlal ❑ Commercial
IF residential, is it q Single Family Detached Q Condoltownhome (single family amdched) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
1- eommercial, Is !t: Ct Sank ❑ Bar ❑Church Cl Hotel/Plotel ❑ Medial office ❑ Office ❑ itetaii
El - Restaurant. . . ❑ other (explain)..._.
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyw, you may need 12 contactN1s1cn17PresermtFbn
If this is for a. demolition permit; what year was the building construd3ed?
lFpncr to 1975, you W71 need an asbesras assessment iv submit wills this applfa t on.
Descripticni of work
,if lawn sprinkler/badcfilow preventer, must list licensed piumbar. IT first-time A)C, muse list iiCEtlspd electrician.
Subcontractors: Usitheco�ripanyna�rtteorGryofFi'Collirlsllce�se=�
Eizctriaan Plumber roe hantca1 Rooter Other,��
I hereby acknowledge that I have read this application and state that the above IniormatIon 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.
Applicant:
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