HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 10/14/2017�^ Plannng, D ievetopcer nrt & Transportaitlon
of 281 N. t C4t-LlnS Fort CoMns,W 80524.0-e Ave P. 580
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
is 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 change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer tine ❑ Photo -voltaic
❑ Ventilation dikWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
nufac tur").
plete all applicable information on the application. Incomplete applications will not be accepted.
piication # R) I- U`109a- Date
For oAke rme a w
b She Addraas (m W*w) Value of Construction (labor, materials, profit)
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a ,, �' j'1' S57S'Cc�ty/state `�v2sr��cp ill( PtwneA70Al _.
scant Name Address City/state zip 331Z.
, 1" 1414 572-ue ,2.. AL-e052�-
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ctor ,�!//nPqtJA1 #JW Address city/state Zip OWZP �
332
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City of Ft Collins Sales Tax #-3a Z08 Are you paying taxes here or by report? ❑ Here Ag.Beport
&xmi rbrtsregz~bya9an&artm Are you paying with your trust amount .,Yes ❑ No
Is his a residential or commercial project? Mesidential ❑ Commerdal
If esidenfJal,, is tt: 36-5ngle. Family Detached ❑ Condo/ibwnhome (single family attached) 0 Duplex
❑ Multifamily (apartment) ❑ Garage
If mmmerdel, is ft: ❑ Bank 0 Bar ❑ Church 0 Hotel/Motel 0 Medical office 0 OfBoe ❑ Retail
E3 Restaurant 0 other (eogftn)
Is is building 50 years of age or mare? d Yes ❑ No 1f)es, you maynaedto mnba ffMarkPA%ervabbn
If Pils is for a demolition permit, what year was the building construcMG
If Pdor to 19Z5, you wrp need an asbe0as assessment to submit KOM &s application.
of work
lawn sprinkler/6addiow preymber, must list ricensed plumber. If lirstfime AIC, must list lioensed decdldan.
LbtCAe=74m ynamreorOtyofRCoMw&-ensae*
( acicnowledge that I have read this appaotlroi and state that the above informatlon is complete and Correct. I agree W
with all requirements conUMed herein and city ordinances and state laws regukftg building construction. I know that a .
is not valid until it has been paid and issued.
Wo
£•d 91ti0-Z9tr-0L6 Auodwoo eoyues uuewlle d61:£0'L i bZ 100