HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 02/16/2018 (2)Feb 20 18,04 15p ellmann service compony
970-482-0416 p 1
C7" of
F6rt Coffins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (Interwr non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Pholo-voltaic
❑ Ventilation 4Mater Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete app6catiorw will not be accealed.
Application # �/ Sy w i
For oRm use a* —
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ZO M e C Q �Y .
Value of Contra on (labor, materlab;, profit)
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Applicant Name Address
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City/State Zip P 33i
Contractor J/"f9,kJA11W--JfjfT Address
C nl.S 8052
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Contractor City of FL Collins Sales Tax #-3a ZOa
Are you paying taxes here or by report? ❑ Here AMeport
sagestarnxantx't9regWWbyMYmrmacrws
Are you paying with your trust account? . Yes ❑ No
Is this a resldenbal or commercial projgct7 k<Residential 0 Commend
If reslderlbal, is is 09ngle Family Detached t7 Condo/townhome (single family attached) ❑ Duplex
0 muWaray (apartment) D (gage
U axnmerdat, is it: O Bank O Bar 0 Church 13 Hotel/Notel p Medical office ❑ Office 13 Retail
❑ Restaurant ❑ Odw (explain)
Is this building 50 years of age or more? t3 Yes 13 No Ifye� you mayneed m cbnlaoctHtstvriePia�ervaGbo►i
If this Is for a demaG6on pair . k what year was the building constructed?
Ifp�vr h� I973, you YW need an asbestos amemmt to wbmit wa ,
Description of work
w unmQ r, mus[ use ircensea plumper. If first-time qfC, must list licensed electrician.
Subconftr n a L&MeavWanynamecrctyafRColkw&& ,o
Sectnaan Plumber -- MedianicaL. Roofer
Otl'mer
I hereby admowiedge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements oontarmed herein and city ordinances and state laws negulabng btuldkg construction = Inrowhhac a
Perrhmit tS not valid anN it has been paid and Issued.
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