HomeMy WebLinkAbout3112 Laredo Ln - Applications/Furnace - 01/06/2020Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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
# IS= 1 (4-Z---) (O1 Date
For off1ce use only
12/31/19
lu U - A-C-
Job Site Address (required)
Value of Construction (labor, materials, profit)
3112 Laredo Lane
Property Owner Name Address I
City/State Zip Phone
Austin Lee 3112 Laredo Lane, Fort Collins, CO 80526 USA (970) 980-4898
Applicant Name Address
City/State Zip Phone
4600 Innovation Dr. Suite 102 Fort Collins CO 80525 970-399-9940
Contractor �Mv MM Im. Address
City/State Zip Phone
4600 Innovation Dr. Suite
102 Fort Collins, CO 80525 970-399-9940
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ e ❑Report
sales tax number is required by all contractors
re you paying with your trust account? Yes ❑ No
52310
Is this a residential or co mercial project? Residential ❑Commercial
If residential, is it: Single Family Detached ❑ Condo/townho tingle family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/ tel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explainY
Is this building 50 years of age or more? ❑ Yes 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/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 #
Electrician Plumber Mechanical 1'r 3 3 q 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: t� p /�I� / l/ 12/31/19
Print Name: l U�1 K/III C L U i/ l Cj Signature Date