HomeMy WebLinkAbout1707 Lakeshore Dr - Applications/Water Heater - 02/02/201202/02/2012 09:25 9704612413
KAHAR PAGE 01
�^F�ort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins; CO 80524
Phone 970-416-2740 Fax 224-6.134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be uasd to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (Interior non-structural) C] Electrical Alteration -(not service change) ❑ Gas tighter D Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement .O Roofing 0 Sewer Line ❑ Photo -voltaic
• Ventilation ® Water Heater ❑ Water Line d Wood/Pellet Stove (must be.EPA certified, provide make, model and
manufacturer).
Complete all applicable
Information on the application. Incomplete applications will not be accaptad.
Application # ow 20 Date 2-2-12
!nor office use only
Sob Site Address (requlmd) I Value of.,Construction (labor, materials, prdFlt)
1707 Lakeshore Drive $ 3,931-00
Property Owner Name ddress
Zip
Phone
1 70
ore Drive/State
Tom & Nanc Crow Fort o
80525
Applicant Name Address
C1ty/State Zip
Phone
(970) 461-
Keith A. Gallagher 6772•N. Franklin Ave. Loveland CO 80538 2412
Contractor Lic # MP-3 7 Address
city/State zip
Phone
6772 N 1. in Ave.
Kahar Plumbing & Heating, Inc.
Loveland, CO 80538 970 461-2412
Contractor City of Ft. Collins Sales Tax # 18874,
Are you paying taxes here or by report?
❑ Here. ® Report
5wnatax numberfsrequfredbya//mn"ctars
Are you paying with your trust account?
IN Yes 0 No
Is this a residential or commercial project77 Residential O Commercial
If residential, Is It: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hbtel/Motel Q Medical office ❑ Office ❑ Retail
CI Restaurant ❑ Other (expfaln)
Is this building 50 years of age or more? 13 Yes ❑ No..Ifkq, you mavneed to contact H/stvIft Preservat/on .
If this Is for a demolition penult, what year was the building. constructed7
Ifprior to i9�5, yvu wl/l need an asbestos assessment to submit with this appl/cat/on.
Descrlptlon of work Remora wat•wr himat•pr
*If lawn sprinkler/badcflow p'reventer, must list Ilcensed plumber. If first-time A/C, must list licensed electrician.
5ubcontf•actors:Clstthe companynameordtyofftColllnsl/cense.#
Eled:rldan 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, 1 know that a
permit Is not valid until It has been paid and lssugd.
Applicant:
Print Name: Signature Date