HomeMy WebLinkAbout1080 E Elizabeth St - Applications/Water Heater - 11/09/201111/09/2011 15:04 9704612413 KAH^,R PAGE 02
City of Planning, Development & Transportation
Fort Collins zsl N, College Ave P.O. Box 580
Fort Collins; CO 80524
Phone 970-4I.6-2740 Fax 2247-6.134
OVER-THE-COUNTER PERMITS ONLY
This application it to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
0 Demolition (Interior non-structural) ❑ Electrical Alteration -(not service change) Cl Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler U Mobile Home replacement Ci Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation $ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be. EPA certified, provide make, model and
manufacturer). ",
Complete all appl(�ab,�g InformAjlo on the application. Incomplete applications will not be accepted.
Application #
For ofl74e use
to
Job Site Address (required) �� I Value of. Construction (labor, materials, profit)
Property Owner Name Address
City/State ZIP
Phone �'
Pg, f�(clsot�l _
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Applicant NameAddress
City/State rp
Phone
(970) 461-
Keith A. Gallagher 6772 N. Franklin Ave. Loveland CO 80538
2412
Contractor Uc # MP-37 Address
CltVState ZIP
Phone
6772 N. FFranklin Ave.
Kahair 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? ❑ Here. IS Report
sales tax number Is required by allmnbactors
Are you paying with your trust account? 0 Yes 0 No
Is this a residential or commercial project?) Residential ❑ Commercial
If residential, Is It: ® Single Family Detached 0 Cando/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerclal,.Is It: ❑ Bank ❑ Bar ❑ Church 0 Hbtel/Motel ❑ Medical office O Offlce ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building 50 years of age or morel ❑ Yes ❑ No If yes, you may need to contact H/stor/c Preservaflon .
If this Is fvr a demolition permit, what year was the building constructed?
If prior to 1975, you wl// need an asbestos assessment to subm/t Wth this appl/catlon.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed eiectriclan.
Subcontractors: Ust the company name or 0ty of Ft Collins llcense.0
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. /�7
Applicant: 7 ,.
Print Nam1,e�519natureUL ?SLR C�Y�, Date 11— g-1