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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 03/15/2017icitycrf oLrrt Collins Planning, Dwaloptwe d & Tran9par" MOn ZM N. Cdiege Ave P.O. Box 5M Fort Comns, m ooS24 . Phone 970.41&2740 Fax 224-6134 OVM=THE-COUNTER PERM173 ONLY This appileatlon is to be used to apply for the foilowine pennHs only (eiweck all that appK ❑ Air Conffionalg ❑ Demogdon (interior n rat) 11 Ete*dwJ Allorallon (not servloe d' conga) i7 Gas Lighter D ties Log 0 Heating Unit 0 Lawn Sprinkler 0 Mobile Horne re0eicamerd ❑ Aoofing 0 Sewer Line 0 Phdo wimi is ❑ Ved1don ❑ Wafer Heater 0 Water Line ❑ WoodMellet Share (must be EPA certified, provide, mom. mortal and manuteewmr). Gom*ft all applioabie iifOrmadon on the spplloadon. Incomplete epplltsailo will nat be accepted. Apprcadon 11 D 13CI (4 bate 311 S/ 17 For Wftg tI38 a7rly 30bT 19ddrM (mMAW,__-- -. ..._. - .-- - Value of Conatrucdon (labor, ntaterlats„ pn�} 75�iZ�'Ist.f/a Ph°'re�j'?'D ate 2 " V-• f✓fs ' SOM 1 ApPlkant Nam Address CRY/SM. �Ip Phone �Za cor,tracmr t.lc # Address City/State Zlp Rate Contractor aty of Ft Collbs Sales ►fit # Are you Wit ism fuse or by mpmV 0 Here oleport saris &XMw*ff-& Mwaledbyalanftdom Are you paying with your ma amount? gYas 0 No Is this a reei wgel or corrtmarCW pn*eW 'Reseal Q Commensal IF rr�dentiei, Is rc AfSirde family Detached 13 Cando/tawnhame (skip family aMwAed) ❑ Duplex C3 hld far* (apartment) Cl Garage If Commernial, is it: ❑ Bank ❑ Bar 0 C mnh E3 Ho*Mobd 0 Medical -of m ❑ Offfoe ❑ Retal — ....._O.Restdurant.. . _C3 Other (explain) -- is aft bAdhV 50 years Otago or more? n Yes 17 No ffye, YW 1WYnWd t0 Ct7nladllM=M PAW&W&W 9-this-Isfora.demotH3oirpemif,whmtyearwasthe7buldtngmnsbvcbed? — ——----- —. _ ..._...__ n'p7farmBQMS yrw w67ne dw a*atus '&?At"W MM Lh6sWcaDiara *If lawn GWUWWIb3M0W Prevent w, must Best Um sed Plumber. If fasttruce A/C must Hst BoansEla elecwMM sub©ontra Lwblem�v .n�anremr@ve�R dlaanse ' `4 r��tetlamCK RooFer. Other I hereby acknowledge that I have reed this appDM4jw and state that the above kftTmMon is wmpb to and Con BCt I;ee to comply with ail tagrrlrarnents Contained herein and cRy ordtr www and state laws regula ft building corobvctiom i imow t>mt a Peranit is mot vaUd untl It has been paid end issued. PreWft mallet jar L-d 4Z£££ZZOL6 00 801AJeg uueuwll3 dL0:90 L L 9 L MY