HomeMy WebLinkAbout2115 Lager St - Applications/Sprinkler - 08/29/2018F6rt Cothns
City, of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVEWTHEmCOUNTER PERMITS ONLY
This application is to be used to apply for the foDlmWng permits only (check all that apply), Q Air Conditioning
13Demolition (inferior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ' ❑ Gas Log
❑ Heating unit ,Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable lin ation on the application. Incomplete applications will not be accepted.
Application # I l (I b1
�� - —JDate
Forofl9ie use only
Soh Site (raq�j` � `Value of Construction (labor, materials, protit�?( fe
S Q QK I , r6K-'f (a (bhs C6
Property er Name Address
L, / �%�� zip Phone
&. �
P/"Y- /G/''r•S 7Pi0/ 640V.�f.d de,( %�%.�.Utrtr epV 4eo.S-61s
Applicant Name Address City/State Zip Phone
L0. lse.roe r!oi.crOl3 5-4 X, 13 is.-/ �:�i l�//.�.a !a, ops-.2/ Q7o- 227- 9030
Contractor Address City/State ZiP Phone
LRs /li/ L /o/.a "65..sl4-11, n !o 0-0.93 970-S-a-?
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sates ter number Is required by aff conhwmrs. Are you paying with your trust account? Q Yes yij-No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: IVSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
IJ Multifamily (apartment) 11 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 13 Other (explain)
Is this building 50 years of age or more? ❑ Yes ;no If yes, you may need to contact Hlstwc Presermiton
If this Is for a demolition permit, what year was the building consttvcted?
lfprior to 1975, you WI/ need an asbestos assessment to submit with this applIcation.
Description of work �c-�/o.� ��tir•• ��
*If lawn sprinlder/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or QY of Ft Collkts 1/cane #
i (J
Bectridan Plumber 118 00 Mixhanical Roofer per
I hereby admowledge that I have read this application and state that the above Information is oomplete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know tttat a
Permit is not valid until It has been paid and issued.
Applicant;j�
Print P1am fl
rr
Signature p2 .
ML S Date