HomeMy WebLinkAbout2809 Mercy Ct - Applications/Water Heater - 03/13/2018Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 R 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 #bldbKV hXb5-43
For offlce use only
Date 03/13/2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
2809 Mercy Court
$ 1,552.50
Property Owner Name Address
City/State Zip
Phone
Diane Hunter 2809 Mercy Court,
Fort Collins, CO 80526 (970) 420-1013
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 M Report
Sales tax number Is required by all contractors.
Are you paying with your trust account?
IR Yes ❑ No
Is this a residential or commercial project? 1Z 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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Install (2) 50 gallon water heaters
*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 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
03/13/2018