HomeMy WebLinkAbout1707 Valley Forge Ave - Applications/Water Heater - 11/14/2017.1-WL
Collins
i
281 iv. College Ave P.O. Bmc 00
Fort COMM, CO SW4
Phone 97"16-2740 Fax 2246i34
This application is to be used to apply for the following penmis only (check all that apply). 0 Air Condiffonfng
0 Demolition (interior non-itruc6ual) 0 Electrical Albeiation (not service change) 0 Comas Lighter ❑ Gee Log
❑ Heating Urdl:,Zl Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line ❑ Phob vottaic
❑ Vengafion Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide maim, model and
manufacture _
Cornpte.{e all appl cabte IrdbnT ateom on the appficatwn. tncom ete applicadom wig not be accepted.
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Pity Owner Name
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Applicant Name
Address /State Zip
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Address:
City/Stale Zip
Phone
Contractor Gip of FL Collins Sales Tax
mx member 6 mqLdmd by A ors
Are you paying taxes here or by report? ❑ Here O Report
Are you paying with your truce account? ❑ Yes ❑ No
Is this a reCh M or project ❑ Resew at ❑ Cammer®I
if reel, is M Shtgte FamIIy Detached ❑ Condo/tnwnhome (single farmily attached) ❑ Duplex
0 NuffamHy (M a tment) 0 Garage
If camm sxK is it ❑ Bank ❑ Bar Q Ctnuch (3 HoWmotel ❑ Medical office ❑ Office 0 Retail
12 RaMneant fQ ottw(eplain)
1s U*bunt tg 5Dye= of age or more? f7 Yes ❑ No If yes, you may rieed to cmttad Hisir t Prat
If this Is for a demollillon pernft what year was the budrfmg amstrvded7
If prior to 1975, you will rind an asbestos moment Lo submit with this application.
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*If loan sptWer/haddlow prevetiter, must list Gaensed plumber If tirsbdme A/C, must list Umnsed eledrtdam
Subcwdracb= fist the company name or City of R Cdlins Rowse #,
I l a" that I have read this applicaton and state that the above information is mmptete and "Duren I agree to
x»m ply wBh aff reUarxerts odd herein and city ordinarsKes and state li nrs mgulating bulft exubrucHarL 1 [scow that a
p 1 Is notvalid until itias been per d and issuedApplicant
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