HomeMy WebLinkAbout1700 Laporte Ave - Applications/Furnace - 04/01/201303/28/2013 08:32 7208646419
LONGS PEAK ENERGY CONSERVATION #2143 P.001 /001
F City. of
ortCotlins
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
;KHeatirig Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ 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 # � ��d Date +1
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
100 Lea. t- Am—
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Property Owner"Name
Address
City/State/ Zip 9057.1 Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
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Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here. ❑ Report
sa(estax number Isregdredbyall cnnbadars
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? K Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 13 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office El office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Ayes ❑ No If yes, you may need to conoa H/stvrlc Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wi//need an asbestos asset to submit with this aAaicab'on.
Description of work
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or Gty of Pt Coll/ns Awnse #
Electridan Plumber Me&animl 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: um,
►flS ► A/1 Signature i , Date 3. 2S —I
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