HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 06/06/2017Jun 2617,05:56p ellmann service compony
970-482-0416 p.2
planning, Davefw at &Tranislmnawn
CtY40j 281 N. College Ave P.O. Box 580
CdUns Fort Coins, c D m4
Phone 970-416-2740 Fax 224-6134
OVER—TH&COUNTER PERMITS ONLY
Thle applicalion to to be used to apply #or the following permfts only (check all that apply). E3 Air Conditbning
❑ Dem=lon (inwrlar norra�raurai) 0 E wtricel AfberaWn (not serhnce change) 0 Gas U*ftr 0 etas Log
f7 Heathtg Unit 0 Lawn Sprinkler E3 Mobile Home rapdacement 13 floofmg O Sewer Line ❑ Phot"ottaic
❑ Venblaffon 4Wa1ar Heater Q Wager lane ❑ WoodlPellet Sims (must be EPA cerNi K pmvfde make, model and
manger). .
Complete all applicable Wbrmadon on the applfcadon. Incomplete epplloadom v dlf not be socepbxL .
E 0
vt�&L Latt� ?
Date
Value of ConslrtrWon pebor, . p�
- ..._
- �3 .
Appifcartt blame Address Citylsb3te . .. ZO .Pho e .
conf etar Lic Address Cityjstaft zip Rme
/��1 rya 01 /MR A//S
-Sx�tw7ra
Corttractor Cxy of Ft Co1►ir>s Sales Tax3 !2v-j--- Areyou paying taxes here or by r ❑ Here glepmt
s raxn�raadbrav Are you fig wtth your beat account? j¢'yes O tdo
Is this a residential or mrnmendal proms j@"Redderftlal Q Coal -
raIF sidenttal, is It ftnt8q Det8died Q Cando/townhamie (single (sty actache� p p
O NuitiPamity (apartment) Q Garage
ff comfrlerBal, is fh O Bmk 13 Bar Q Church ❑ Hopi 0 mediml-dace 0 office G ReW
_. _Q Reslaurarft Q Other (explain)-.
Is tlhrs 6WkIng so yaarg of age or more? ❑ yes ❑ No
If Oft-ts fora. demolmoa permit what � I�u /neyneed m contact p/�,y�
IFP *rtv 10M }faHr was the builidhtg mnsbwcbed?
Yv fw,7mdao a �tp Wj* lyn(s� - --
*if lavari sprirdder/b fitter, Mu* Est Amused plumber- If nmt-thme AM must Bst Icarmind6!@Cbtlpart, 4ubcontraGt m Ltd thaaosogot�nyiaanmorG�yafFPLbV�rssltcease
Electrioi� per.
ROO Other
I hereby with
anwied9e tl+ati have MW this aAPdl MUM and state that the above lnrb nwftn Is
amply w$n t its awuatned herein and MY ordlna cas and 5tg a laws ° and °� I agme to
persertt is trot valid tent8 it etas t pard and fstred. rtgulating fw&ding eor I know that a
Appif
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