HomeMy WebLinkAbout915 Laporte Ave - Applications/Furnace - 02/21/2019City of Planning, Development, & Transportation Services
Fort 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
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. Incomplete applications will not be accepted.
Application # (061m o Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
"V 6— fGry=
Property Owner Name ( Address rCCiity/IStatte� gZip Phone
II / `IoUi`Ci1 K;_k4 � '/' T 06 i`/L� D 9057(
Applicant Name Address City/State Zip Phone
KedY'YV 11)" lb-zl-66-77
Contractor Address City/State Zip Phone
4,4r\ (S ,-bn �65 5_71 A),wkC�kqMb (6 gait 170-566-YzU
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required byall mntractcrs. 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 [I Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work ]rn,�a1O,w "F;vrnctce- 1or- vpSJaikfs lilttncl ctrPs(
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # A M,,wrq and A '( —
Electrician Plumber Mechanical "40ik- Rotifer 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: �Q, f�p,� Z
Print Name: n a6V " ` Signature Date Zr I — l 7
Revision date 26/2017
.bins
Site Address: 2109 LAGER ST
Job Valuation: $2,900.00 Category: Residential
Transactions
Community Development &Neighborhood Services
281 N. College Ave Fort Collins, CO 8o522
970.221.676o 970.224.6134 -fax
Building Permit #: B1808432
Issued Full: 09/28/2018
Permit Type: Residential Roofing
Method Check Number Date Paid
Amount Paid
Comments
Trust Account 09/28/2018
$140.31
Receipt issued: 09/28/2018 Total Paid to Date:
$140.31
Fee Description Account Code
Fee Amount
Amount Paid
Date Paid
Amount Due
Building Permit Fee Without 1000.422010
$76.50
$76.50
09/28/2018
$0.00
Subs
City Sales/Use Tax 251.122030
$55.83
$55.83
09/28/2018
$0.00
County Sales/Use Tax 100.217030
$7.98
$7.98
09/28/2018
$0.00
TOTAL FEES: $140.31
L, t�
$140.31
$0.00
DUE AS - OF 0j9/28/2018: 0.00
Fee Amounts are valid for date of this document only: Fees subject to change without notice.