HomeMy WebLinkAbout5125 Stetson Creek Ct - Applications/Water Heater - 10/24/201110/24/2011 10:04 9704612413 KAHAR PAGE 01
Planning, Development & Transportation'
City/ Of 781 N. College Ave P.O. Box 580
Fort Collins Fort Collins; CO 80524
Phone 970-416-2740 . Fax 2247.-1i134
OVER-THE-COUNTER PERMITS 'ONLY
This application It to be used to apply for the following permits only (check all that appiy). 0 Air Conditioning
• Demolition (Interior non-structural) ❑ Electrical Alteratlon-(not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ ventilation X Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be. EPA certified, provide make, model and
manufacturer).
Complete all applicable informatlon on the application. Incomplete applications will not be accepted.
Application #_:?211 P(A Date 10 2 4 11
For office use on y 1 Q'
Job Site Address (required)
Value of.Construction (labor, materials, profit)
$875.00
5125 Stetson Creek Court
Unit A
Property Owner Name
Address City/State Zip
51 y Stetson Creek Court, Unit A
Phone
(970)
Marilyn Edwards
Fort Collins, CO 80525
266-1779
Applicant Name
Address
City/State Zip
(970) 461-
A Gallagher 6772
N Franklin Ave Loveland; CO 80538 2412
_Keith
Contractor Llc # MP-37
Address
Clty/5tate ZIP -
Phone
6772 N. Franklin Ave.
Kahar Plumbing & Heating,
Inc.
Loveland, CO 80538' 970 461-2412
Contractor City of Ft. Collins Sales Tax # 1 8874
Are you paying taxes here or by report?
0 Here. E Report
Sales tax number Ismqulredbyall contractors
Are you paying with your trust account?
(3 Yes ❑ No
Is this a residential or commercial project? 'l Residential 0 Commercial
If residential, Is It: ® Single Family Detached E1 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ church El Hotel/Motel ❑ Medical office ❑ Office C1 Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ID Yes ❑ No .If yes, )vu may'need to contact Hlstarlc Preservation
If this Is for a demolition permit, what year was the building constructed?
,rf prior to 1975, you will need an asbestos assessment to submit w/b'r thls appllcadon.
Description of work Replace 4Q gal war r heat
f-If lawn sprinkler/backnow l reventer, must list licensed plumber. If Flrst time A/C, must list licensed electrician.
Su bcontractors: List the company name or C ty of Ft Collins /!tense. i
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 constructlon. I know that a
permit Is not valid until It has been paid and Issued.
Applicant: lc �4 II
Date
Print Name: Signature