HomeMy WebLinkAbout1700 Laporte Ave - Applications/Furnace - 11/27/2018�.F'City of Planning, Development, d Transportation Services
rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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
b.f}leating 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 # A 19 Jo�v5 Date
For office use only
,ob S Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
�7u 431-10��
Applican ame Address City/State Zip Phone
Contractor Address City/State Zp Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? $04ere ❑ Report .
sales tar number esrequlfWbyall convaaws. Are you paying with your trust account? Vies ❑ No
24025
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is R: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No 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
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List bye company name or O[y of Ft Coffins license 0
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:
Print Name:_S s� akemy. Signature �►e "�,� Date ak
RBYisim date 24=17
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