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HomeMy WebLinkAbout1624 Northbrook Dr - Applications/Water Heater - 01/16/201401/16/2014 .08:15 9704612413 KAHAR PAGE 01 City. of Planning, Development & Transportation 281 N. College Ave . P.O. Box 580 Fort Colt -ins 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). 0 Air Conditioning. © Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log • Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 0 Roofing ❑ Sewer Line 0 Photo -voltaic q Ventilation 0 Water Heater ❑ Water line 0 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 # Date 1-16-14 For office use only Job Site Address (required) Value of Construction (labor, materials, profit) $ 3,287-00 Property Owner Name Address City/State Zip Phone Chris Robertson. 1624 Northbrook Drive (970� 227-7307 rnTb 11 r'ril 1 -0«, fin.-... Applicant Name Keith A. Gall Address er 6772 N. Fri Contractor LiC # MP-37 Address Kahar Plumbing & Heating, Inc. Contractor City of R. Collins Sales Tax # 18874 Sales tar numbwIs reiquired by all mntractbrs City/State Zip Phone 970- Lin Avenue Loveland CO 80536 461-2412 City/State Zip Phone 9 7 0 - 6772 N. Franklin Avenue. 461-2412 jj pyqland 38 Are you paying taxes here or by report? © Here P Report Are you paying with your trust account? IM Yes ❑ No Is this a residential or Commertlal project? KI Residential ❑ Commercial If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex O Multifamily (apartment) ❑ Garage If commercial, Is It: ❑ Bank i s gar ❑ Church © Hotel/Motel ❑ Medical office A office 13 Retail ❑ Restaurant . C] Other (explain) Is this building 5o years of age or more? O .Yes ONO Ifyes, you may need to contact Hlsfar/c Preservation If this is for a demolition permit, what year was the building constructed? ffprior to i975, you wi// need an asbesins azaWnerrt to submit w/di t56/s applhat/on. DOscription of work N, _ *If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Ust the company name or Gty of Coln &'rose 4 Electrician PlumW MechanlcaL. 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: Print Name: Signature Date `�� `