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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 08/12/2017Ptanning, Devalopuma aLTranwor 251 N. College Ave P.O. 9wt 580 Forttoilns, CO80524 Phone 47o-416-274D Fox 224-M4 OVER-THE4)OUNTiER PERMITS ONLY This applicalon late be used m apply far the fotlowinS PetmfTs y (check ati ffiat apply Air Cotpf%ionln9 O DemoMIm (irdsdor nw"nCftn* Q Beadcal A9era8on (not serefca ehenjA O Gas Lighter Dew Los ❑ Heetfng um ❑ um Sp&kw a Mobile Home rim Cl Roofing O Sewar line ❑ Photo-vo9eic d V adHahOn 4Waier Heater 0 Weller Lira a WaoWMet Stove (met be EPA cer ffi¢d. Pry make, model and man achue�. Compleft ail ap0 ablle hltommflon on the apWlcWom lnoampk to applications will not be accepted. AM6cadon #_ to ) f�70 ':7 ; n q Date V /z//z AwaftsumaA& w! / L(�itg,L'vi�LJ�?.✓ L value all /(clson NMI mate�i� prate -- - ea-vC4AtL-ttk AdetreSSCTS�jiZC�Y/��kcanv. FhorsS'?ii AM FAWfic:mr:k Address Ctty/sbm ?rP phome, �%C Oohbacbvr Lie# Addrrm my/slift Zfp Pltm R- !F 5 A' =" g 510m7ve SAMUL 5,5h9 i Contractor M of FL Colffns Sales Tax ie 3Frao4(-- Me you Wft Wm lie or by repot!? O Here Wkepmt S sEararmr6�Prrrwr&edL�aaowrtramor� Are You f g %ft yw out aoeo mt? gyas ❑ No Ls &As a residentW or mmmsrdai pmjmV OReddwtfaf ❑ Commercial 1f n , is tt -gr4e Pamily Defadmd II CondWW w*home (s(ngfe famW aaactted) Cf Duplex Q���p�3 GaMe IFmmmwdat, is it- Q poft D t4edka105M Q Ofrlae !3 Retart --CiAumurant. Q Athes (expwin).-- rs this buffding 80 years of age or mwa? oyes E1 Ne Ify leru/neyneadlo G/ XCFn ! Itthts-fsforaden HOonpen3 t,whatyearwasthebuttdingooneftdmd? - FijJJPCYtD19T3 yCuiraY/n6addllah7_4lMlid'w/MSAIen,.n74�Mrr.. --- — - - Lawn 90rfnWer/badtNrnr Pam, must Mttlaased pgrmber ff fhsb•Cme AIC must ft s elxbt 1C077b iP$OfSL 11R'DE@m/A�rq�7/B Of C�yC1�R'CC�7S�69ttra+3 . Imofer Claw hera d all ge emti have reed t}ds apWWU0n andwham tliettfie above Mkrnaawn h complete and o� I peeto a m lywy Is bowel l� abW and tW CrdJfm= and 9ft taws rpubft bulfdfng co mbuam. S rmax2bat a be=paid and June& L d 9170-ZWOL6 Auodwoo eotmes uuewlle dL£ £0'L 6 LO deS