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HomeMy WebLinkAbout703 S Bryan Ave - Applications/Water Heater - 04/18/201204/18/2012 10:48 9704612413 KAHAR PAGE 02 City of Fort Collins planning, Development & Transportation' 281 N. College Ave P.O. Box 58d Fort CoIlIns; CO 80524 Phone 970-416-2740 ' Fax 7.2+76.134 OVER-THE-COUNTER PERMITS -ONLY This application la to be used to apply-fdr the following permits only (check all that all0y). 17 Air Conditioning ❑ Demolition (Interior non-structural) Cl Electrical Alieratlon-(not service change) O Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement L'1 Roofing. ❑ Sewer Line ❑ Photo -voltaic * Ventilation CkWater Heater ❑ .Water Line 10 Wood/Pellet Stove (must be.EPA certified, provide make, model and manufacturer): completo all applica a information on the appli atlon. Incomplete applications will not be accepted. Application # a -Date a 1 R 1 9 For o ce use only .lob Site Address,(requ/rnd) • Value ofconstruction (labor, materials, prdflt) 703 S. Byvon Avenue 1 $1,075.00 Property Owner Name Address Clty/state zip Phone 703 S. Byron Avenue (9.70) 493;0920 Jim & Ruth Anderson Fort Collins CO a0 8 Applicant Name Address Gty/State zip ( Phone 4 61— Keith A. Gallagher, 6772 N. Franklin Ave. Loveland CO 80538 2412 Contractor Uc # MP-37 'Address - Clvstate zip ^ Phone 6772 N. ranklin Ave. Kahar Plumbin2 & Heating, Inc Loveland, CO 00538 970 461-2412 Contractor Clty of R. Collins Sales Tax # 18874• Are you paying taxes here or by report? ❑ Here. W Report salestax numberlsrequnedbyoil rVatracrws. Are you paying with your trust account7• IN Yes O No Is this a residential or commercial project? E1 Residential ❑ Commercial If residential, Is It: M single Family Detached, CI Condo/towhhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: El Bank C3 ear d Church © Hbtel/Motel E3 Medical office ❑ Office O Retail D Restaurant 0 Other (explain) Is this building 6o years of age or morel G Yes D No -if yes, you may -need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Ifprlor to 1975, you wl// need an asbestos assessment to submtt w/dr (fits appl/cadon. Description of work Replace water heater — Add Floor drat V lawn sprinkler/backflow•preventer, must list licensed plumber. If first-time A/C, must list licensed ale.ctrlclan. Subcontractors: Llstthe company nemeorL7tyofnZatllns/lcense.0 Electrician _ plumber. Medranlcal. Roora 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 Issugd. Applicant: Print Name: Signature Date