HomeMy WebLinkAbout7217 Laramie River Dr - Applications/Sprinkler - 06/10/2014F, 6rt 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 XLawn 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 # 1�?-)m0 Q(0)Qn
For office use only
Date ob o l 00 I /'o Vl
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
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 Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
I%Report
Sales brnumber &requiredbyall mnftacmrs.
(_�) 2,I 28 9-1
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ 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 )iKNNo If yes, you mayneed to contact HistoricPieseruadon
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 T1AI- C F P1 rA k t R- SYS f i�j
*If lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List fltecompany name orCity ofF?Collins license # j { 7— 331 1
Electridan Plumber DpH 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. _ r1 , A
Applicant: �GQA., HE'Ci
Print Name: IJ
Date I o 1