HomeMy WebLinkAbout1607 Lakeshore Dr - Applications/Furnace - 12/22/2016Fort of
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). it Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Vbeating Unit awn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ater 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.
i
Application # 15 oo7bO9 , J51 L-o7fo I fl i
For office use only IN UO 7lo I I
Date
Job Site Address (required)
Value of Construction (la materials, materials, profit)
7
�JCJ
Property Owner Name Address
City/State Zip
Phone 303
S
0-70 -aa 30
Applicant Name Address
Zip
Phone&/
/City/State / -
Contractor Address
City/State Zip
Phone
Contractor City of Ft. ollins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required pyai onractors.
Are you paying with your trust account?
❑ Yes lr o
�-_- o VS C p,- J(�D
Is this a residential or com rcial project? IVResidential ❑ Commercial
If residential, is it: 1i ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ 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 LH46 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 Roofer Other
o�_
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: �.k �V�A-� Signature Date (�