HomeMy WebLinkAbout4030 Capstone Ct - Applications/Water Heater - 05/13/201911 28 N. Ci
e ofte Ave P.O. BW 5BG
.gf� -on
Fort acm, GO 805N
Phone 970-416-2740 Fax 224-6134
I bisappficaffor. is to be used vDzppIy-.-b.-the jbftwmg penmils only (cbeck alithat apM. 0 Air Con&ucnmg
0 DemDriffon (mmnor non-slfudur4 13 Elia-mcal Afteraflon (not service dmge) 0 Gas LOW 0 Gas Log
13 Heating UriD Lawn 9xktkIer 0 MoNe Home replacemeni 11 Roamtg 0 Sewer Lkw Ij PhohvioREfic
OVentREllonNffaierHeater ElEtter Line 0 Ifflood(PeWSWe (curse ber:PAceded, pmWde malce model and
ManufachHUT
AppHcaUm*:- 96�C(C)3199
Fbr V-11ce use aly
Date 5-13 -11
jb SFm M*,m (rqEtreo)
Vakm a Coasbucgoa @dW, mabffkaft proft)
Propen-f Owner Name Address
PAZ ffikeber L-I 01720
CkyjRate-
cf- co
Phone% i
01 5—y'i
1,1,a—
APPUCaA Name AddressCW/StAe
zo
Phone-7,2c
LLC- 6ai Ir A N-3 IS
-lf kPI Yj&�j rIc-
n�srv p
9Vq9CVZL I
Addre&--
cly/stme zo
Plum
cmwd= apf Of ft coWM Saws TW-, -t--
Are you paying taxes here or by geporQ 0 Hem
❑Report
You payMg wiffi your uust aooDmiG EJ Yes
0 hia
V is this a residerift PUjeCL? OReshlealial OCam-,MrCial
if re9deaM, is fc FariuiY DaMdied 0 Condpfwmhame ftauatxh(sWwed) E3 Dupkx
1IW&Mw*(qmtmant) OGarage - g4e
ff aamet4 is t o Bank o cz-, g aun-di n Howmatei 0 Medial office 13 Offum 0 Retad
D0067er(e#ffn)
is tfds bu-dft SO years- gage or nmra? E3yes r2No llry� you may need to awlad Msaic PrassvafiDn
IF tics is for a what year was the buffclng amristructecP
IF prior in 1975, you wM need an asbestos asseawrent t[) submit wM #ifs appBmffon-
UT— U-11174M
IffirstriAMAIr- Must HSE�2d deftenaL
Via' List the =npafty rom or 0jy of Ft Cal grz k3anm ---
EwWiCm�� PIUT�PqaacaiR—W— OUW
I loeby admonfeEge that I have read tins apprim5m and sbVe that the abovainfixxnaffm is complate aid' I lagraetD
ply >9ith a$ rzq�aritads carnaared hararr read illy arxi siaie Ears r Corr. F � a
is natvaDd MrM WWasbemn paid ara3 lssir