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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 04/23/2019Apr29 19,07:17p ellmann service compony to Super-Iinnpyf hOWh S'gns a��g oW d p.4 � s�an� s:ss✓,nn �� -THE LINTER PERMS ONLY This appllcatior4 is to be used to apply for the fogawing permits onV (check all that aPPIy).13 Air Condhi(ning 0 DemoM0n pniretfornonshvotuW) l7 ElecblWAlteretion (notswAce chop) ❑ DaslJghter C Oas Log 0 Heaong unit ❑ Lawn Spdrdder ❑ Mobile Ham replacement 17 Goofing E7 Sewer Una E2 hOb- oiialodel and 13 Ven%Aon �Neter Heater © Water Una i] Wooditllet Stove (muabe EPA certified, pr manufadwra - bd COMP left al➢ a►opl "ble informatioa amble applica4tnn. Ifi miDist® apAllcattons h>afll not b®accet Application * -&i 6, 0 a 8 a`1 DEft �7 311,q Araeka use only 970-482-0416 2K N. Co>lege Ave PA. Box 580 Fort tom, M 80524 ph= wo-4m.274G Fax 224-0% Sob FagAddtrew (jeqjW Vdlue of Coaatnmdon (labor, materials, proof:) �m.7SC.OtIr/Staie�2vtulxtlp �i[I ( Phaneg7L' Co-�SI � vim Applicantftne Address MOM ZIP Phu 33iZ eQ / 1y1 o9 ry l l A & CIty/Slate Zip gy33 Contractor�0�'jas47�l�i it iP pddre55 �7r✓�ViGc I �i� �.G�� zuc� '� CD Contractor Cl y of Ft. CblUns Sales Tax #-M 2,06 Areyou paying ttw here or by report CI Here 04VOTt ales tarnumber rsn3gtrlradbya0mntraderz Are You paying with your Met aacounC? Akyes 0 NO Fs tills a residential cr mn modal ptujesC? bfj�=-dentfel 0 0ommercM ii'resldential, is it: 12MIrVe Famly Detached Q CandtifiDwnhome (siaglefamUy aidaci4 0 Dapfex IH Muldfamly (aparttne * M Garage if mmmeTdal, is R: ® junk 13 aw 0 Church 13 Hotel/Motel 13 Medical office E0 Office ®Aetati 0 Restaurant 0 Other ft"n) is this building 30yelw ®i age or more? G Yes G No Iry�, yournairnagdia m�ctfils�taricPres>9r►sab'an If this is fur a ftrnatat an Peitarrr't, udiat year was the building constructed? Irpfbrio Ion you wFneed an awwwme tiosubmk wadi H& aPPFMVM. Description of V lawn sprinlda lbrMaw preverstBr, must Ust MMed Plumber. If first -line AA must list Hwmil elechician. �ePss�ivr®i�oee: !f�'tile aarr�oanyname orGF[y ofFtColli�sGee� #� aces cen Plumber = Ra far Ctlter I hereby aclatawledgs thud have read this applirmGon and-SEstiEthat tare above infoimdon is o mPlexe and come&- I agree to comply vdth all ieq mmw is cantalned harem and ft ordinances and state laves regulating building coistruciim 8 lemgs that a gi4t'8ihtt is moi eht� unit it hes taean Baia and bred. 3 tPs;l iwwwAittlethings.comJruMy-ehureh-signsnutoLsoume-lGu&utaLmodium-Facebook Page 10 of'12