HomeMy WebLinkAbout1148 LAPORTE AVE - APPLICATIONS - 2/20/2013Glt Of Planning, Development & Transportation
Fort or N`llins, a Ave P.O. Box 58D
"_ Collinsv , 1 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
O Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler 11 Mobile Home replacement ❑ Roofing ❑ Sewer Line El 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 applicatia n
Application # BlaGOT]S
Por offlce use on/y
Job site Address (repu�ie+d)
Property Owner
Applicant Name .
Contractor City of FL Collins Sales Tax #
aLSales tar nq ba^is /red 6y a// ronGacto
ns wi not he accepted.
Date �- a O
Val u of COnstrllctlon (labor, materials, profit)
5 l "70 '7I
Address, city/state Zip Phone
1 f V\r•440 ... G'r/' . /qn �n � — —
Address
City/State
44
Zip
Phone
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? Airyes ❑ No
Is this a residential or Commercial project?, Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Cl Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office El Office El Retell
❑ Restaurant [7 Other, (explain)
Is this building 5o years of age or more? ❑ yes JtNo IF yes, you may need to contact Historic preservatlo/r
If this is for a demolition permit, what year was the building constructed?
1r'priar to 1975, you will need an asbestos assessment to subm/t nad7 this app/ic 30'7
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of 8 Collins license
electrigan Plumber
�_ Mechanical` Roofer
--�� Other
I hereby acknowledge that I have read this application
hentalned herei
Permit Is not valid until it he End state.that the above inrorrnatlon Is complete and correct. I agree to
comply with all requirements n and city ordinances and state laws regulating building con
s been paid and issued. struct on, i know that a
Applicant:
Print Name
Signature .7
Date Li- 12 --