HomeMy WebLinkAbout1418 INDIAN PAINTBRUSH CT - APPLICATIONS - 3/2/201203/02/2012 09:34 9704612413
KAHAR PAGE 01
Fort of
Planning, Development & Transportation•
281 N. College Ave P.O. Box 580
Fort Collinsi CO 80524
Phone 970-416-2740_ Fax 224-5134
OVER-THE-COUNTER PERMITS ONLY
This application 18 to be used to apply for the following permits only (check all that app1•y). ❑ Air Conditioning
O Demolition (Interior non-structural) O Electrical Alteration .(not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing .❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ClWater Heater ❑ Water Line fO Wood/Pellet Stove (must be. EPA certified, provide make, model and
manufacturer).
Complete all applicable Information the application. Incomplete applications will not be accepted.
Application # �L� O ()LJ _ Date 3-2-1 2
For oMce use only
PJob. Site Address (tequimdJ
Valuo of, Construction (labor, materials, profit)
1418 Indian Paintbrush Cour
$1,b50.00
Property Owner Name Address
Clty/state Zip Phone
230 N. Sunset
Jack & Allison
Street
s, CQ--ane21 —
Applicant Name Address
City/State Zip Phone
Keith A. Gallagher 6772 N. Franklin Ave. Loveland CO 80538 (97024�121
Contractor Llc fk MP-37 Address
City/State Zip - Phone
Kahar Plumbin & Heatin Inc.
I N. Franklin Ave.
Loveland, CO 80536 970 461-2412
Contractor City of Ft, Colllns Sales Tax # 18874.
Are you paying taxes here or by report? ❑ Here N Report
Sales taxnumber Ismqulredbyadcontrvctom
Are you paying with your trust account?' ® Yes O No
Is this a residential or commercial project? n Residential O Commercial
If residential, Is It: M Single Family Detached ❑ Condo/towhhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank Cl Bar d Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain)
Is tills building 50 years of age or more? ❑ Yes ❑ No .If yes, you may need to contact H/stor/c Preservatlon
If this Is for a demolition permit, what year was the building constructed?
Jrprlor to 1975, yvu will need an asbestos assessment to submit with tills appllcat/on.
Description of work Replace Wafer FTpnt-cr — Sn gal Nat gag
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Listthe company nameorCltyofFtCollinsl/cense.
Electrician plumber,
Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above Informatlon Is complete and correct. I agree to
comply with all requirements contained herein and dty ordinances and state laws regulating building construction. I know that a
permit Is not valid until It ha-4 been paid and Issued.
Applicant.
Print Name: Signature Date