HomeMy WebLinkAbout1625 W Elizabeth St - Applications/Water Heater - 01/07/2014Planning, Development & Transportation
Fort of � 281 N. College Ave . P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740740 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.
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter q Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
q Ventilation IR Water Heater ❑ Water Line ❑ Wood/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 # S1g000gq Date 1-7-2014
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
1625 W. Elizabeth 1 21250.00
Property Owner Name
Address
City/State
Zip
Phone
Faith Property Managment
300
Boardwalk Drive
970-567-7473
Applicant Name
Address
City/State
Zip
Phone 970-
Keith A. Gallagher 6772
N. Franklin Avenue Loveland
CO 80538
461-2412
Contractor Lic # MP-37
Address
City/State
Zip
Phone 970-
6772 . Franklin
Avenue.
461-2412
Kahar Plumbin & Heatin
g Heating,
Inc.
Loveland.
Contractor City of Ft. Collins Sales Tax # 18874
Are you paying taxes here or
by report? ❑ Here W Report
saiestax number Isrequired byall mntraaors.
Are you paying with your trust account? ® Yes
❑ No
Is this a residential or commercial project? k) Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage.
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant . ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?.
if pr1or to 1975, you will need an asbestos assessment to subm/t with this app//cation.
Description of work Replace 75 Nat. Gas Water Heater
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical 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.
Applicant: 9� .Signature & /' �tY C� I '
Print Name: ' _ � � � Date