HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 10/19/2018Dec 2618,09:23p ellmann service compony 970-482-0416 p.1
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FbrtCo����� 281.N. College Ave P.O. Box �0 span
,;1_ Q. ftrt OOWVS. 00 805Z4 970
(%r . • Phone 970-41616-274Q Fbc?24-G134
OVOtrTH9m OUNTTER PERMS ONLY
This application is to be used to apply for the follwMng permits only (check ap OW apply). 0 Air ibriditio t
O Demolition (interior non-structural) 17 Electrical Alteraiian (not service change) O Gas tighfar C7 Gas Log
❑ Heating Unit ❑ Lawn Sprinlder 0 Maple Home replacement ❑ Roofing C7 Sew ar Line 0 Rmtoweradc,
❑ Ventilation dikWatar Hadter 0 Water Lhre 0 WoodlPeM Stove (must be EPA cerIfied, provide males, model and
manufacturer).
Complete all m9cable kh madon on the appikslion. Inaompiele epplkoions WTO not be accented.
Application # Date l�
rwAWM �ddve S e -
3ob Ske Address (n:gr*wq value of construction (latwr, marerlelsTP
2G e fir. a2 Z.
�e a� `,�^�' SSiS Gc`�ts►/ t2 �1t81t,1 uckcd; `mac t Phone4770 —
Co . 221-53zs
Appilcot Name Address tIly/Smte 21p Pho 331Z.
PwN It -If 4 E . � ffi52
Wnbad+or �///n;W&1 1W.46 Address cky/staw ZIP A6F
33
�7 67p_%A C' J I C4ESpauC'" CO
Conbadar My of Ft Collins SelesTax #-3205 Arayau paying taxes here or by report? 0 Here Aaeport
Sslestaxnranba*Wn�vtradbyaUc°ntredws Are you paying with your trust account? Ages 0 No
Is this a residential or mmmerdai pro oW b5tesldentlal 17 Cammerdal
If residential, is It O fn& Family Detached 13 Conde%towmhome (sirsgla family aMuclied) 0 Duplex
CI Multifamily (apartment) 0 Garage
If mmmerclab is iC ' 0 Bank 0 Bar O Church 13 Hotp- Motel 0 Medical office O office 0 Retali
❑ Restaurant E] other (explain)
Is this building .y0 years ot? age or more? Dyes C No lfyer� youmayneadm cnrrbrtt wicPres�taiion
If this is for a demolMon permit, what pear was the buliding canshueted?
ffpricr In 197S, you will need an �s�sa�nrenffnsubmit with 1hlsapplii�� .
Dmription of work
�.
V lawn sprfnlftfi iclOw pr, ant er, must fist Umnsed plumber. If first-time Afq must list Umnsed eiectrndan.
subantni ws:LWWecvnwnyfrawor07YO tCollurs&am9
Elemdm plumber - AredYanrmi Reofvl Other
I hereby admcWedge that I halm Bead 9itts appiixatio -mw state e= the above utrorrna an is rnmpiete and cmTec . I aide to
comply with all n:qukemerits wntalned herein and city ardlmEms and state lism mjub iing trwwmg eoristrui ion. I kww that a
rseatttit is that vaUd until R bee been paid and issued.
Appli — d
ease
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Planning, Development & Transpoltebm
City of 281 N. College Ave P.O. Box 580
Fort Collins ��970-41166-2744004 Fax 22+61M
I '
OVER-THE-COUNTER PERMITS ONLY
*Eris application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 17 Gas Lighter 0 Gas Log
0 Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
M Ventilation A&Water Heater ❑ Water Line 0 Wood/Pallet Stove (must be EPA certified, provide make, model and
all applicable information on the application. Incomplete applications will not be accepted.
it �I)bq qq 9 Date
For o��&*
lob Site Address (reauhlew
qoV7alue of Wrsruetion (labor materials, profit)
ow er � Address 136S S • City/State p Phone 7D'
`.`"..
Applicant Name Address
City/State Zip �31Z.
Ad At
e. 4��JS g052
r 0///f'1 a4rJ^-1 Address
City/State Zip ep z
font,
� Ns CO z
Contractor City of Ft Collins Sales Tax #-3a ZOa
Are you Paying taxes here or by report? 0 Here ;9W1 port
Asates&rnwnderlsmq~byamav as m
Are you paying with your thin accoLW. Rr Yes Cl No
As this a resideitiai or commercial project? . -KResk itial ❑ CommercW
,111f residet6al, [sit, 06irigie. Family Detached 17 Condo(townhotne (single family atladted) ❑ Duplex
0 Multifamily (apartment) 0 Garage
41F commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 oRioe Ci Retail
i 0 Restaurant 0 Other (whin)
Is this building So pears of age or more? ❑ Yes 0 No Ifya4 yav may creed m cxzt?d'A*tmricPnvsffvafw
If this is for a demolition permit, what year was the building constructed?
Ifprior to I975, you Wined ap asbestos assessment m svbmk w7h dws aM*0 ion.
Description of work
0
*If lawn winlder/baddlow preventer, must list licensed plumber. If firsirtime A/C, must Rd lkxrsed electrician.
Subcontractors: LEit ft ewnpany name or Oty OR Caffw ficeyW #
Bech'ician Plurhd = Metllaniml Roofer
Other
I hereby adc iowiedge that I have read this appliicaton and state that the aboae inPorrnation Is complete and correct. I agree to
comply with as requirements contained herein arul city ardlnances and state laws negulOng buWmg construction. I know that a .
permit is not vaNd untA It has been paid and Issued.
Applicant:
Print Natfi
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