HomeMy WebLinkAbout1320 LAKEWOOD DR - APPLICATIONS - 1/10/2013Jan 08 01 10:14p
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Fort 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 4Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must tie EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not he accepted_
Application # ew'9f 52 Date 1-10
Foroffice use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
I 3RO LAKEWODD
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43; 900,00
Property Owner Name
Address
City/State Zip Phone
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DIL Ed OLL AIS ( 0 lSQ ! 47i1 .j`il .7��
Applicant Name
Address
City/State Zip Phone
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Contracbor
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales
Tax #
Are you paying taxes here or by report? JX Here ❑ Report
saiestax number isrequ,edbyascontractors ,
Di4!
Are you paying with your trust account? ❑ Yes ► kNo
Is this a residential or commercial project? 121�,Resldential ❑ Commercial
If residential, is it: I(Single 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 b( No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? _ N Q
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinklerlbackflow 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 #
Bedrican Plumber MP` 7.;? .a Mechanical Roofer
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. 1 know that a
permit is not valid until it has been paid and Issued.
Applicant:
Print Name: [-a ✓; d t'ya-Icto Signaturq _ Date 03