HomeMy WebLinkAbout904 Laporte Ave - Applications/Reroof - 08/02/2018,FoCity of Planning, Development, & Transportation Services
rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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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) Cl Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement W- ofing ❑ 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 w' I not be acce ted
Application # �> I colo u b q Z)
For oliice use only
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Date Uq Z
Job Sitq Address (required) Value of Construction (labor, materials, profit)
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Pr erty Owner Name Addr`ss�, City/State Zip G Phone
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Appin�t amAddress Citaq
y/State Zip Phone
SZC1 iE� Ad 4b+ fie` 14CC51(l o . Z
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins oes Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales &xnumber esrequiredbyall conrracma. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co� erdal project? esidential ❑ Commercial 1
If residential, is it: IR 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 S ❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work y ^"
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty 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 a rrect. 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: TDT,Signature44
Date
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