HomeMy WebLinkAboutpitkin.eh.273503200017 (1996) Fireplace Registrationavironmental Health Department
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Parcel
-,Parcel ID # of Property (available from Assess r, 920-5160) ,?7 3 s� o `SA - p o -o t,-7
Name of Owner of Property? J
Owner's Mailing Address cl 0 tb �
Street Address of Property r . r. r 'v ` 6 0
Legal Description of Property
Owner's Phone Number
Structure Type: Single Family ® Duplex ❑
Apartment ❑ Commercial ❑
If this is new construction (not a remodel or addition) :
Type of device # you plan
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Condo/Townhouse ❑
Other ❑
• If this is a remodel or addition to an existing structure:
For the fireplaces/woodstoves you already have:
• what devices will you be adding?
Tvne of device # added room
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make/. Model:;(attach s . ec sheet
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Signature of Applicant Date 1�-d receipt #
Envir Health Dept Approval LQ DateDate Paid W fee'. - r.e.novI PI
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