HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 03/11/201914 Super-F try Ch h �pRs
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281 N. College Ave P.Q. Box 560 atan. s:3z Ana
Fare Qlilins� CO 5004
Phone OX 4M-Z74O ft n"24
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This i pplicaftn is to be used to apply for the foilwidng permits only (check all that app1Y). O All• OmWithtning
13 De nciltitm Anterior non-*uctuml) m Electriael Aieamtlon (not ser*A change) a Gas Ughtsr 17 Gas lag
O Heating tlnti ❑ Lawn Sprinkler 13 6l oblis Home replacement ❑ P.00ft 0 Sewer Llna Q photow;OWc
13 Ventilation &jWatar Weaatu Q Water line a woodiPeliet Stove (must be EPA twilled, provide make, model and
mane lure!).
Co bb ail alablivabl® illfarmatioir on the appilimlion. NteomAlei® ap>,ucaftn- will not be �e- v ( o Lj-S ly T"d
i J:bP Loa usennly
Xob S, MAdfims (l2gmW
_ vague of coYl'ebucdon Qabcrr Matedds, prom)
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App ntName Address
Myles�31Z..
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5tkcc �. A �52
Cont6dvr�%llnAYJAJ W-4q Address
Gty1 tote ZIP 3
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fur= - -9Gjreff Adi Q
Con der CRy of Ft: Collins Sales Tax #� �a
Are you paying taxes here or by raport? ❑ liars P4m
sups numtertsregvtredrrya9mrmaara
Are you paying with your 15U51 axaunt? .lYes 1No
is qs a residential or commernl pra)est? AReMential Q CammerdBI
if na;ident[al, is jiGgie Family oewhed Q condo)bwnhome (single family ettaciied) a Duplex
Q Multifamily (apartment) 13 Garage
If i menial! is it; 13 Bank 13 ear 13 Church Q Hotel/NioW Q Medical office Q Office Qtail Re
II Mahout ut Q Other (explain)
is th building W ymm e age or more? Q Yes Q Mo ify ycumayn�adid canlact 'c Pr�9rvabTan
if this is for a damalitiM peamltf what year was the building constructed?
IFpi or to 294 you wXnW an asbeaw am w=wttta&&me W& b*APpllS90bn.
of work
*if lawn sprinlder/baekHow pYMMt'rf must list licensed plumber. if lhst-time A/r., must list Accused eiettrlchm.
Ou t darmWYhaco PW4ameorCdyofFtl ft f -f
Piunthar = Met Rantai Rode Otlter
1 adinc wledge that i hm read this appIIcalion and-stdlSdM the above lttfpmtation is compieta and mrrett I agree uo
with all requw ffients contained herein and city ordinances and state laws regulating building cmstrudd= I l'cawthat a
is not vM unto it has been paid and issued.
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