HomeMy WebLinkAbout2833 Canby Way - Applications/Water Heater - 05/31/2017Planning, Development & Transportation
City. a6 ` Collinsor N. College Ave P.O. Box 580
i ` .7 Fort Collins, CO 80524
Phone 970-41616-2740740 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 (hntenor non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation l& Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable information on the application.
Application # � I V UT
For olTrce use only
Incomplete applications will not be accepted.
Date
05/31 /2017
Sob Site Address (required)
Value of Construction (labor, materials, profit)
2833 Canby Way
$ 1,182 00
Property Owner Name Address
City/State Zip
Phone
Jim Ippolito 2833 Canby Way, Fort Collins, CO 80525 (970) 402-8033 (970) 491-8028
Applicant Name Address
Gty/State Zip
Phone
Keith A Gallagher 6772 N Franklin Ave Loveland, CO 80538
970-461-2414
Contracbor LIC# MP-37 Address
City/State Zip
Phone
Kahar Plumbing & Heating, Inc 6772 N
Franklin Ave Loveland, CO 80538
970-461-2412
Contractor City of Ft. Collins Sales Tax # 18874
Are you paying taxes here or by report?
❑ Here M Report
Sales taxnumber Is&Tuimdbyall contractors
Are you paying with your trust account?
IN Yes ❑ No
Is this a residential or commercial pmject7 ® Residential ❑ Commercial
If residential, is it: IN Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or morel ❑ Yes ❑ No If yes, you may need to contact Histonc 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 50 gallon water heater
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or 01 y of Ft Coffins 1XWse #
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 bo
comply with all requirements contained herein and city ordinances and state laws regulabng building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Jeff Gallagher signature Jeff Gallagher Data
05/31 /2017