HomeMy WebLinkAbout427 S SHIELDS ST - APPLICATIONS - 8/29/2018City of
Fort Collins
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 W 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 #
For ofce use only
Date 08/29/2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
427 S. Shields Street
$ 1,400.00
Property Owner Name
Address
City/State Zip
Phone
Kathrin Hauptfeld 427 S.
Shields Street,
Fort Collins, CO 80526 (508) 667-4710
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. ® Report
Saks tax number is required by a//contractors
Are you paying with your trust account?
R Yes ❑ No
Is this a residential or commercial project?
If residential, is it:
If commercial, is it:
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contactHistonc 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.
❑ Duplex
® Residential ❑ Commercial
Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
Description of work Install 50 gallon water heater.
❑ Retail
*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: 08/29/2018
Print Name: Jeff Gallagher Signature Jeff Gallagher Date