HomeMy WebLinkAbout5415 Belvedere Pl - Applications/Water Heater - 01/04/2018City Of Planning, Development & Transportation
281 N. College Ave P 0. Box 580
F 61 rt Collins Fort Collins, CO 80524
�.— Phone 970-416-2740 Fax 224-6134
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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 ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation R Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
ComplI� to all applicable information on the application. Incomplete applications will not be accepted
Application # 1✓ I�DO I - � ( Date 01/04/2018
ii For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
5415 Belvedere Place
$ 1,864 00
Property Owner Name
Address
City/State Zip
Phone
Kregg Listen 5415
Belvedere Place, Fort Collins, CO 80525 (970) 581-1892
Applicant Name
Address
City/State Zip
Phone
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Keith A Gallagher
6772 N Franklin Ave Loveland, CO 80538
970-461-2414
Contractor LIC# MP-37
Address
City/State Zip
Phone
Kaliar 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 tax lnumber isrequired byall contractors
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Are you paying with your trust account?
l& Yes ❑ No
Is this allresidential or commercial project? ® Residential ❑ Commercial
If residential, is it: ® 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 ❑ ❑ ilding 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is'Ifor a demolition permit, what year was the budding constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace (2) 40 gallon water heaters
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
List the company name or City of Ft Collins license #
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 budding construction. I know that a
permit is not valid until it has been paid and issued.
Print Name: Jeff Gallagher Signature Jeff Gallagher Date 01/04/2018