HomeMy WebLinkAbout2319 Coventry Ct - Applications/Water Heater - 04/11/2014(e,
Of Planning, Development.& Transportation
City 281 N. College Ave P.O. Box 580
Fort Collins 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
q Ventilation ❑ 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 # F / y 01 T40 Date . 4-11-1
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
2319 Coventry Court 1 $ 1,878.79 - Material
Property Owner Name
Address
City/State Zip Phone 970
2319
Coventry Court Ft. Collins, 80526 484-
Tim Swearingen
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-
Kahar Plumbing & Heating,
Inc.
6772 N. Franklin Avenue 461-2412
LovelandCO 80538
Contractor City of Ft. Collins Sales Tax # 18874
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Are you paying taxes here or by report? ;.Here
sales tax number is required by all contractors
Are you paying with your trust account? IS Yes ❑ No
Is this a residential or commercial project? KI
If residential, is it: ® Single Family Detached
❑ Multifamily (apartment)
If commercial, Is it: ❑ Bank ❑ Bar ❑ Chun
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
h ❑ 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 pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace water heater - Navien 240A t•ankl Pcc
*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:
Print Name: Signature
Date 4/" 11 _ 1y