HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 12/06/2016Dec 29 16 08:07p Ellmann Service Cc 9702233324 p.3
Planning, De ralopnwa 8r. Tranr)ortwcm
Gty, of 2a N. College Ave P.O. Box 580
Collins rort Collins, Ca 8M4
Phone 970-416-2740 Fax 224-6134
. 0.VER=THE-COIiKER,PERM"t-Mall ONLY.
Thle application Into be used to apply for tha foilowlag permtts only (check all t ifft apply)..0 Ail' Condftlorkw
0 DemolRton (Interior non-suumurai) : 0 Electrical Alteration (riot service dhange) 0 eea Ughter ❑ Gas Log
O Hea" Unft 0 Lawn Sprinkler E3 Mobile Home replacement ❑ Aoafing O Sewer Line 0 Pkwto-voltaic
0 Ventilation ❑ Water Heater Q Water line 0 Wood/Peliat Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application # - 12.Mc. -72b
Faroe use onfy
Incomplete applications will not be ecoeptsd. .
Date
Value of eonslruction r, matarials, f�)
.. - 41
i VtiwF` L't) Ad�?rS�j'1+:.�Y/S b�' Phoney''j�
Sk 2So 42-1-44
- `Ul
1 Applicant Name Address Cry/State Zip Phone
Ccvitrootvr LiC Address City/Slate ' ZIP Rmne
Contractor City of Ft Collins Sales Tax 3k;;ZvJ-- Are you paYhv taxes irate or by Mort? 0 Here XReport
Sa/eFtdx lsra9tBralbXa9m a s Are You PaYhV vukh your Mistammine? f'Yes CI No
Is this a residerrblal or (mmmemdal project? WResldentlaf Cl Cwa ierdai
IP residesntfaf, ls.1t BfSingle Fw*V Detached O Cando/towmhome (singfe t`amoyr attached) O Duplex
o Mur&� rwly (apartment) ❑ Gard
T` camrnercW. is ft» D Bank D Bar D Church D fio*MoW Cl Medical office D Offlce O Rail .
-..O other(explain)--...
�9 Yearn oi' age or morel ❑Yes D lvo Byes, J'�/ �Yneasd Lt7 Gv!l1�GtI�ls�7C 3f-this-is for a. dentoTfSon permit, what yearwas the-bu@ding mnstrur PrisPJLi3�
-
�P�fo-49?3,youwn7needanasb�a itv.s&ArMMVWapt — -- -- ------
*If fawn SOMMer/baddiow pewter, must IIst 8eersed plumber. If flrsE-lima A1C must list t6aExesed
Subcorstraetprs= 1tst�ie gleeprldan.
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I hereby aelaroenefedge that1 have read thts apPrxatim and since chat the a complete and
comply wth all herein Bove ►nibnnation is
cRy ordinances and stale laves re erg bup clan. I I agree to
permit is not valid untU R has been part and Tsstrad, g g d� ter: i teaowthat a
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