HomeMy WebLinkAbout3032 Rock Creek Dr - Applications/Water Heater - 10/31/2018Of Planning, Development & Transportation
Cit
r_ -_1 CoRinc For N. College Ave P.O. Box580
^�(`�"�'-'i .7 Fort Collins, CO 80524
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 [0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # '1'� 1 9a % (Q o�
For ofil're use only
Date 10/31/2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
3032 Roc creek Drive
$ 1,050.00
Property Own r Name
Address
City/State Zip
Phone
Phil Kilkus 3032
Rock Creek
Drive, Fort Collins, CO 80528 (240) 994-5437
Applicant Name
Address
City/State Zip
Phone
Jeff Gallagher
6772 N. Franklin Ave Loveland, CO 80538
970-461-2414
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 0 Report
sales tax number is required by all contractors.
Are you paying with your trust account?
IX Yes ❑ No
Is this a residential or commercial project? ® 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 more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace 40 gallon water heater.
*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 #
Electrician
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
10/31 /2018