HomeMy WebLinkAbout1111 Kirkwood Dr - Applications/Water Heater - 02/01/2013Jan 31 2013 10:23AM Gary Hooley Heat and Air 9702249198
page 2
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.Q. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demofi6on (interior nonstructural) 0 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
G Ventilation M Water Heater ❑ Water Line 0 Wcod/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 61300t4Ra
For office rue only.
Date 2/1(2013 0-1
Job Site Address (required)
Value of Construction (labor, materials, profit)
1111 Kirkwood Drive
$890.00
Property Owner Name Address
City/State Zip -
Phone
Dennis Graham 3549 Soft Wind Point
Castlerock, CO 80108
970-224-4446
Applicant Name Address
Clty/State Zip
Phone
Dennis Graham 3549 Soft Wind Point
Castlerock, CO 80108
970-224-4446
Contractor Address
City/State Zip
Phone
Gary Hooley Heating & Air 1314 Webster Avenue
Fort Collins, CO 80524
970-493-3272
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here (M Report
•sa/estax rmonbe<6;.eqz~byarreo„bma�7M
Are you paying with your trust account?
M Yes ❑ No
34734
.
Is this a residential or commercial project? M Residential 17 Commercial
If residential, is it: 0 Single Family Detached 9 Condo/townhorne (single family attached) 0 Duplex
0 Multifamily (apartment) 17 Garage
If commercial, is it: 0 Bank 13 Bar ❑ Church 0 Hotel/Motel C] Medical office A office [f Retail
C3 Restaurant 0 Other (explain)
Is this building 510 years off age or morel O Yes ❑ No &yrs, you mayaed to contact N/slnric Preservation
If this is for a demolition permit, what year was the building constructed?
Opdor to 1975, )vu w/// need an asbastas assesurnent to submit with this appllcatlon.
Description of work Replace 4o aallon water heater
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-ttme A/C, must list licensed electrician.
Subcontract m: List the company name or Cafy of Ft Co/tins license #
Electrician Creekside Pbimber Mechanical H-1654
Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
I
Appl
Print : Shelly Swanson Signature �J
Date
-v