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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 07/18/2016Jul 2516 11:35p Ellmann Service Cc 9702233324 p.1 planning, Development & Transportation 0� 0� n 281 N. College Ave P.Q. Box 380 �+ Fort Collins Co 80524 (-.'o� nS— Phone 970-415-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). Ci Air Conditioning ❑ Demolition (interior non-structural) ❑Electrical Alteration (not service change) ❑Gas 1_ighier ❑Gas Loa CJ Heating Unit ❑ Lawn Sprinkler C1 Mobile Horne replacemeni ❑ Roving ❑ Sevier Line'. ❑ phoi:ovoliaic ❑ Ven►ifaiion ❑ Water Peaier ❑ Wafer Line 0 WoocVpeilet Stove (.'mist be EPA certified, provide make, model and manLlacturer). Complete all applicable Information an the application. Incomplete applications wl(1 not be accepted. Appiicai ion # 40433 5 Date r For office use only Value cf Construction (labor, materials, profit) job Site Address (required)C La ; i•'1 ��L' ,yfC S .4 �, i ei Address Cy/Siate(��(re�uco Phonef pet din L'i� ���� cJ ac -, Spy#I - 5x Applicant Name Address City/State Zip Phone =- rf` l _ Jar %��=L �� �'J i �i J f'�% � 4'�d' % .-•� � ~- GontraCcvr U[ Address Y City/State Zip r�s�+��� >�f��[ Contractor City of Ft. Collins Sales Tax t �� Afe you paying. taxes here or by report? ❑ Here ZReport Salmi bxnunb risregtfimdbyall contracaurs. Are you paying with your trust account? G'yes ❑ No . Is this a residential or commerciaf project? _tU' Residentlal ❑ Commeireial if 'residential, is Ft7 Single Family Detached ❑ corldortownhvme (single farnlly aivached) Q Duplex ❑ Multifamily (apartment) © Garage if commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ i-latel/Motel ❑ tiledical office ❑ afnce ❑ Retail ❑ Restaurant 0 Other (explain) Is this building 50 years of age or more? i] Yes i7 No r yes you lTlayriBBd to C017tvgct HfStoric Preservation V, this is for a demolition permit, what year was the building constructed?. .ir -lor to 1975 you will need an asbestos aseagsment to submit vlitn t,5is application. Description of work "if lawn sprinklerlbactsr'low preventer, must fist licensed plumber- If first-time AiC, must: list licensed electrician - Sub con traCors: U& the company name or Grf o,"Fr C0111WIRE,75e Electrician Plumber" i4echanical Roofer Other i hereby acknoWedge that' have read this application and state that the above fnrormation is complete and correct. I agree to comply with all requirements contained herein and cite/ ordinances and state laws regulating building construction. s know that a permit is not valid Until it has been paid and issued. r, Prime Name: ���)r���� ��I�.n a. rT Sign EC -` _-: ---�� Data t f 1