HomeMy WebLinkAbout1608 Laporte Ave - Applications/Plumbing - 04/27/2012Cit Of Planning, Development & Transportation
FY 281 N. College Ave P.O. Box 580
ort Collins 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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application
Application #
For offlce use only 2-19
Incomplete applicati ns will not be accepted.
Date / @L
Job Site Address (required) Value of Construction (labor, materials, profit)
$20
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
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( Fib 1 66 765
2K63L%3776,5
Contractor Lic # Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
Sa/es tax number is required by all contractors. AV
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or corriroemial project? ' °�Kesidential ❑ 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? ,Erfe-s ❑ No If yes, you may need to contact Historic Preservation
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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must ' icensed electrician.
Subcontractors: List the company name or City of Ft Collins license # L v %
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: n
Print Name. nI� Signature Date