HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 12/08/2016Dec 29 16 08:07p
Ellmann Service Cc
9702233324
p.2
Planning, Development &.Transportation
Fort College Ave Boot 5 P.O. 80
JE 25, CoWns 2"'Fort Cdlins, CO gpg24 .
Phone 97"1&2740 Fax 224-6U4
0V- E-RwTH.EwC- OUIVTER PERM � ONLY
This application Is to be used taapply for the Wowing permits only (check all that apply). C3 Air Caldtlating
❑ Demolition (interior non-sinwtumQ : 0 Elearicel Alteradon (riot service change) ❑ ties Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprii`d¢er 0 Mobile Home replacement ❑ Roofing D Sewer Line O Photo -voltaic
❑ VenfiWan ❑ Water Heater Q Water Line 0 Wood/Pellet Stove (must be EPA certified, provitle make, model and
menufai�urer}.
Complete all applicabl (information on the application. Incomplete applications will not be aecepisd.
Apokariort # . �� �—�—� �iy Dater
Fora ceuseonly
20b9 Add t'r d.�.._ ... Value of Cons IiCtl i (labor, maWials, MOM)
AddresIS 7""{Z,�Y/� *494MA PhoneyP7 (
Applicant Name Address City/Statie - Z10 Phone .'
�i��'��a i�r•�lG.w.��rif '`/= �' 1 �G "��'S � �?a �� 3�i
o� � Ga'rei IAx
Gontrodrn tic V Address City/State.... zip p1
.�!-��.o.•r,,,f �.l�Tzra.b �f =�i� S.�re 5/�.�.r S�r�. ..
Contractor City of FL Collins Sales Tax # 3k.;Zcs-j-- Are You traf tng t3M here or by reporV D Here ($'Report
Sales laxrmrn!>erlsre�e6a?bys9CobM29M Are you paYtn9 vrtth your trust account? WYes O No
is this a residential or commercial projeW OResidential 0 Cornmerclat
if restdenNel, is itr 0Single Farrdly Detached 0 Condo/Mmhome (9Ve family dilated) 13 Duplex
13 Multifamily (apart} E3 Garage
P commerclat, is it Cl Banc 0 Bar ❑ Churdr 0 HOWIMoos 0 Medical office ❑ Offfm II Retell
.---'.Restaurant.-.O.Cther
is this builds go Ce�lafi)_--.
n9 years ot` age or morel D Yes D No 11` - -
-If this -Is for a dernoWeon 1as,1 1 mayneeato Lr�+1l�7hl5foiyt
1]'O1117rI019%S �►�• whatyear was the building construcbeda ---- -- - --
, you r�7laeed an 21osufimlt ar�iGt t)YlsappA�R -
*If lawn spanfdar/baddiaw preve W- must list licensed �umber. If firsL-bma� Subs �must anntrectorm Lisitlrs e�� �TftCaPrsLi�enree
trhmlbar _ s -
Roofer Other _
I hereby With
811 acknowledge it atI have read herein aokWOn and SWM that the above MmMUM is cvrnple>a and correct I
comply with ali r�7uinernents contained cW ordlrenoes and state 6aevs agree to
pwmlt 18 netvelid until it bas been paid and )=us& slating buHdin9 wnstrucdon. 3 knawrhaY a
Applicant!
f�rhnt P]arne 7.a.»�s r �•, - eye Date J2 /(