HomeMy WebLinkAbout2807 Stockbury St - Applications/Water Heater - 02/06/2018'City.Of Planning, Development & Transportation
��` Collins 281 N. College Ave Fort Collins, CO 80524 O. Box 580
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 ❑ 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 appy ble��pmation o the application.
Application # I�()D
For o>irce use only
Incomplete applications will not be accepted
Date
02/06/2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
2807 Stockbury Drive
$ 2,124 00
Property Owner Name Address
City/State Zip
Phone
James and Angela Mooney 2807 Stockbury Drive, Fort Collins, CO 80525 (970) 218-7664
Applicant Name Address
City/State Zip
Phone
Keith A Gallagher 6772 N Franklin Ave Loveland, CO 80538
970A61-2414
Contractor 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 DO Report
5a/es tax number Isrequvedbyall contractors
Are you paying with your trust account?
IA Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: CR 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 more? ❑ 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 (2) 50 gallon water heater with pans
*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 #
Electnoan 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: Jeff Gallagher Signature Jeff Gallagher Date 02/06/2018