HomeMy WebLinkAbout1121 Laporte Ave - Applications/Reroof - 10/04/2019Planning, 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 ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # 1F � 611 a q -�'(2 Date ni 190
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
J
Property Owner Name Address City/State Zip Phone
►\\ -7.7o-sepp-LaM
Applicant Name Address City/State Zip Phone
8A AWiI-PJ&ndT0537 -1- i
Contractor Address City/State Zip Phone
t .R 5 7 P704- '?-n
Contractor City of Ft. Collins s Tax # Are you paying taxes here or by report? Here ❑ Report
safes tax number is required by all contactors. Are you paying with your trust account? XYes ❑ No
AlID!q`1
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: Fl,Slngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) X1 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? ❑ Yes Pf No rf yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of workeary....u. 4Va5 ;.g4CC-Pr. mr"mil\ of p& ascl:.
\N� ►-, .Rc irps. C .tea ( -.4ki4ZAS, 1 zkc6% _.-y-tr --^
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first- ime A/C, muk list licensed ele rician.
Subcontractors: Llst the companyname or City of Ft Collins license # Q ` y
Electrician Plumber Mechanical Roofer t%� 1 d9 Other
I hereby acknowledge that 1 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: uY�%C%.- signatur Date TV 1919
HOWSIon date 2)810W