HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 02/22/2018Is
Plamdm owellopmant &Transportation
291 N. College Ave P.O. Box 580
Fort Cditf CO 80524
Phone 970-416-2740 Fax 224-6134
- OVER.T"E.COUNTER PERMITS ONLY
appillm fiV wilon is to be used to apply
for the tollow1109 permits only (check all that apply).12 Air conditioning
trtgRtion (irtterlor non-structural] ❑ Electrical Alteration (not service change) 0 Gas Lighter O Gas Log
6rtg UnitLawn Sprinkler 0 Mobil Home replacement 0 Roofing ❑ Sewer Line 0 Phomaroitaic
be EPA ce��' model and
N*lation &{Water Heater ❑ Water Una ❑ WOOdfPeffet Stove (mustrtiF�
Piet$ all apAiicablo (ni0rmation on the api lleatlon. income
lete
ticatiort # 16\ t 1p s
For oAfm use Orly
Site Addnttss (requflad) Value
Name Address City/state
will not bs
ft rmatarlaK Pry)
-:3l (p• 7:�>
Zip
�B5111 , Phoneg70 -
Ili -5325
rr • •,.• -- - Zip {acne- -
actor i01M �^1 #VAW Address city// n/S 5:3,
�szlftl, / 't,"1 Ll 73(ut E ❑Here .�-BePort
recce; City of fit: Coffins sales Tax #� ZC� Areyou prong taxes here or by report?
tact or City
lsn ll Collins
Sales
a Are You paying with your trust account? . es 0 No
this a residerftl or commerdal project? Residential 0 Commercial 0 Duplex
residential, is it: V-single. Family Detadted 0 Condolt awnhome (single family attached)
0 Multifamily (apartrnernt) 0 Garage
commercial, is It: 0 Bank 0 Bar ❑ Church ❑ Hotel/Motel 0 Medical office 0 office 13 Retail
C1 Restaurant 0 Outer (explain) u need to cagad tffs&w Prerervatian
this building 50 Years of age or more? 17 Yes Q No lfYe� Yo may
need
is for a demoMi■n permit, what year was the building constructed?
Fpnar to 1975. you wX need an asbe%vs as ssment to sub a,t KO b%; 8A*ffm on.
of work
eeb t-
*If tavvn SpriNder/baddlow Prever"r, must list Boet>sed Plumber. If first-tkM ND, must list licensed el
subcowactom Lisrft wnwwnwV or 12YofFtCoftsAwnse #
Elecb'idan Plumtr�
Methal Rooter Otlter
I hereby admDwiedge that I have read this aPpflmtion and stabs that the above irt%rmatiorn is ComPW%B and Corred- I agree to
Comply wRh a0 requirements oanWned herein and city ordinances and state laws regrdating building eonsbund3at. I know that a -
pennit is not sand wdl it Im been Paid and issued.
AppllOut
print bail?
Date 212� /X
9•d
9640-Z9V-0L6
Auodwoo eoi/ues uuewlle dL£:VO'9L 9Z Inf