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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 08/18/2016atyaf F6rt Co- UIns Planning, lfleveloptnent BLTransportaidon 281 N. College Ave R.O. BOX 580 Fort Collins, CO 80524 Phone 970-415-2740 Fax 22+604 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the follouuing permits only (check all that *PPIY). 0 Air Conditioning 0 Deinoli"don (interior non-structural) .E3 ElecWcai pAeration (not service dhangs) 0 Gas Lighter 17 Gas log 0 Heaft Unit II Lawn Sprinkler 0 Mobile Home replacement [3 Roofing 0 Sewer Line ❑ Photo -voltaic 0 Ven`ilation 13 Water Heater 0 Water Line 13 Wood/Pellet Stove {must be EPA certified, provide make, model and manufacturer). Complete all applicable iniormsiion on the application. Incomplete appRoations ill not be c P' Applica ion .9 �,I � 80� Dare l S 1 b Fo amca' use aN r Y 30b Site Address .(raquf[e*- Value of Construction (tabor, materials, profit) _ . qz ULAdL P e$ Ltt Addresst�t,,?5 "i�,CrtYlsi .e�n�w Phone'"" ycala.:* =Utrl ate 2 Applicant Name Address CiNState- �` ,ZP Phone - /- f —v, �.? S L�•�sy f �is r� l :rt: -f-, =-/'. 1G �,dl 1 44VK 2:5 —n . UvntfoCtor L.ic Address CitylState Zip Phone O io ve j c �� Si4r:% 5,5A Contractor City of Ft. Collins Sales Tax * 38 <<GEr Are you pay -mg taxes here or by report? 0 Here WfZeport, sales tax number israWiredby-Jconfrciam Are you paying with your trust account? RrYes ©into Is this a residential or cornmerrial project? WResidential 0 Commerdal Yf residential, is it. OSngle Family Detached E7 Condo/townhome (sIngle family attached) ❑ Duplex 0 Mu[iifamfly (apartment) 0 Garage rf cornrnerciaif is it 10 Banc: 13 Bar C1 Church 17 HoteVMotel © Medical office 17 office 0 Retail . .13 Restaurant. ❑.Other (explain)..._ Fs -this bW[ding 30 years of age or more? ❑ Yes ®No Ifyes, you,mayneed to mntact Hlsmrrc Presenr ffw If•this-is for a.dem; onion permit'" whatyear was the building constructed? _._ . fiariar to I975, ydu Wit nerd an asbaRDW Messrrlent LO.wbmltW& ih15a0,000 on. )ri of work *If lawn'sprtnk1&/J ackf1ow preventer, meat fist licensed plumber.'. V i:rA-time A/C, must Fist licensexi eled3ician. Subcontractors: GCsr" the cpmpar�yna�e orGg� vfFcColtinslicznsa El Oldan Plumber "~ Mechanical Roofer Other I hereby acknowledge that I have read His application and state that the above fnformaUDn is complete and correct. I agree bo comply withall ne(Uirements contained herein and city ordinances and state laws regulating building construction. I know that a permit is not valld until it has been paid and Issued. Applicant: Print 3Vaine•d�»1J 6'd VZ£££ZZOL6 00 aouuag uueual13 d09:L096 t,L 15nV