Loading...
HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 05/31/2018IWORINUM pNF499UP59mmI a -- - 3Kt = N Cofte Ave P 0 Eax fat t Gomm Go I3024 Moe 9M 415-2740 Fax 224.6134 6/3117 9 32 AM OVER-THE-COUNTER PERMffS ONLY This appl wftn Is to be used to appal/ for the >Toliawina permits only (check as thd applY) CI Air Conditonrng p D wwNon (Interior non -crud rat) 17 Eleahlcal Aitem*m (riot setv[W aheW) 0 Gas Ughter 17 Gas Log O g Unit ❑ UNM Spnnlder 0 Mobile Home replaaawft 0 Bourg C1 Sewer Lino 0 Pha itt an A Nater Heater D Water Late 13 Wood/pdat five (must be EPA carlilied. Provide make, model and https pleb Sy a mttation on the eppllCatlon lemoitnp!@t@ 8pp9eations will not be accepted ucatntm � Bate For aise wly SIM Address (regret W vahm of Constracdtot: tom, notm ls, prOM zS1L AA, 55'75 �e.�y+Is�al�e "�+��vp �� 11 Phoneq"7 0 l mrt Warne AddreSs citylsm ZIP phow'3312= ' rtiv f�i� F �1s $052 tracbar W/)? �A! 41" Address cltyistmZIP �WA�l rector pay of Ft. Cotltrts Sales Tax #-T6 74)6 Are you PaybV taxes here 4r by report? © Me raxjwmtxrtsmprvdbya#awkedw-2 Are you prAng with yowtruce ac munt? Ai Yes © No Is a retsideftal or ammtterdai Doge t? .KRedder►tial 0 Commercial If denttal, rs ft a CamW Oeta&ed 1:7 CondolWwrftme (shrgle iiarr+lly attaclyd) Q Duplex © MultifamIly (aparibne V D Garage if merdat, Is iG Cl Bank fl Bar D Church 0 HoWMottel Q Medical office L7 office 13 ReWl Cl Rasiaurant 0 Other (explain) , Is bullftg 90 years of age or more? D Yes ON* Ify yyaarlmaYn+dsd io a fo4isG tP as if is for a da naWon per*. what Year was the hAdhV aonstruded? - m I , you warneed W aMM&W MOOFFMt 90 AdMt rr+ & 6WV of work iaW gruww/baddtow prevent w, must Rst awned plumber If first-tim Aft must Est Rend elechida r Lwmeazap Wnawor01yafftGofs &&Vgf Plumbs' t eawftj ..,...._ -- Roofer Other f adamariecige that I have read arts appll aWn and MM drat ON at eve Udbn Wan 19 ao WWR and coned. i agrme too vultlt all its corftined herein and d W ordnaum and stale laws MgulaWrg bWW% ewwftd m I: bmw that a Is an vald antm it has bwe paw MW wed ae. 5�3(/r � Page 10 of 12 Z d 9Lt,0-Z9tr0L6 Auodwoo eowes uuewlle d9£ 90 9L 6L unf