HomeMy WebLinkAbout601 FOXTAIL ST - APPLICATIONS - 12/27/2019F& '� r3
phonks Dwjdq ment IL Transporbaw
281 N. Ave P.O. Box 560
Fat Courts, 00 60524
Phmne 970-416-2740 Fax 22+6134
OVWTHE-COUNTER PERMITS ONLY
Ibis, appikadon fs to be used to apply roe Ow following pwwas only (dm" all awe apply). O Aft Cond lioning
• Demolition (interior non-struceurel) O Elate Alienation (rot service dwee) D Gas Low 13 Gas Log
O Heatbtg Unit D Lawn SprWdet O Mobile Home replacement O RodkV O Sewer Line O RwWvoltdc
O Ventliaeon 11 Water Heater CI Water Line 13 Woo Vallee Stare (must be EPA card ied, provide make, model and
manu%cturw� I ' ,
CompMM a6 apollicable inrorm■lion on tyre application. Inoartpletsappilbations will not be acaptad.
won # 6 � °11 q � Cp ( �e �l� �/E 111.
., ,
0 • i w/. �C
/ �I C . ✓. i �� WFOANOAIK'��
'.:r '.r.. - -i r. roc
■' �c r• Ir
r.
r � .:.'Ir • r r
r r d d C:I tom- r. r Lr r
■ U r
Is M a rrsiclenYM srproud? 04esidential D Oonvnerdal
If residential, is it; ramNy Debdk O Cando/towohome (gn* family atPa W D Duplex
O Garage
U commercial, Is it: O Bank 0 Bar o Owch O Hotd/Motd ® Medical office O office O Retail
® Rcstsurant O Other (eptain)
Is this build" 5o yeatz of sp or more? ores O 10 Myra; yuv may need m cgntact H&V* PY Lion
If this is for a'dasdWw parmit, what year was the bull ft oanstructad?
.rfp r to 197S, m wN nwdan asbesW assawnwt to vdmff *0 ft 40129m
*If lw m wblcw/badtow preventer, must list licensed plumber. If fast -time A/C, must list liammd eledrkm.
Subconbastms: lost the cxr4panynam cratyafFta*inAmm O
PWmber MedranW Rooky Other
I hereby admowiedge that I have read this application and state Mat the above lnfcrrrcMm is comps and cwrect I agree to
comply with all requirements contained herehs and city okl1wrwes and state laws.regulating buWkkg mnwuction. I know that a
permit is not valid until it has been paid and l= d
tarirs! Signature Date