HomeMy WebLinkAbout907 E LAUREL ST - APPLICATIONS - 8/8/2011Planning, Developtnent & Transportation
FlitCollins For N. College Ave P.O. Box 580
(� 1 ' Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
r
Thin 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 Io Rooting ❑ Sewer Line ❑ 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 applications will not be accepted_
Application # 611 o!J"y Date
FI& 09m use only
Sob Site Address (required)
Value of Construction gabor, materials, profit)
907� 904 C _
LC4,VT,\ SJL"
Property Ow er Name
-r;-N\
Address
clo7-F- L.4vr
City/State Zip
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Phone
as►31P-"�s
Applicant Name
Address
Gty/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Gaon W , Comas rFLo Uvwwc> 'R029
- 4Q 1►
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
■ Here ❑ Report
"es tax numbertsrequuedbyall rnnaactws
Are you paying with your trust account?
®.Yes ❑ No
J/S A39
Is this a residential or commercial project? ® Residential ❑ Commerdal
If residential, is It: N 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 56 years of age or more? ❑ Yes *No ifyes, you may need to contact Histmicpreservabon
If this is for a demolition permit;, what year was the building constructed?
if poor to 197S, you wl// need an asbestos assessment to submit with this app/icadon.
Description of work
Q (AA%ES
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; List Uie company name of CAY of Ft Co///n9 AOMW t
elemclan Plumber Mechanical Roofer R- 1.510 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 laeued.
Appliran : �t5b (S i W _ Mahe �� I y��" — ^� 1�
print Name: S Signature Date