HomeMy WebLinkAbout401 E Prospect Rd - Applications/Water Heater - 07/16/2019City, of Planning, Development & Transportation
t Collins For N. College Ave P.O. Box 580
■ 61
Fort Collins,
CO 80524
Phone 970-41616-27402740 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 # Q) 1 C) C) Sq s 3 Date
For oh`rce use only
07/16/2019
Job Site Address (required)
Value of Construction (labor, materials, profit)
401 E. Prospect Road
$ 1,320.00
Property Owner Name
Address City/State Zip
Phone
Tom Rhodes 401 E.
Prospect Road, Fort Collins, CO 80525 (919) 323-7189
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?
Sales tax number isrequired byall contractors. Are you paying with your trust account?
❑ Here N Report
fA Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: lA 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?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace 50 gallon water heater.
*If lawn sprinkler/backnow 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: Jeff Jeff Gallagher Print Name:Gallagher_Signature 9 Date
07/16/2019