HomeMy WebLinkAbout908 LAPORTE AVE - APPLICATIONS - 4/11/2014CI Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FQ CQI�inS 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 9-1Sewer 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 #18I�T D 17OS Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
'?o S 1,4 0de
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Property Owner Name Address
City/State Zip
Phone
60b 6aj.) l08 G/;r
iC,a,4- 6ollf✓s Co
9'70 212-2n
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? *Here ❑ Report
Sales tax umber is required by all contractors.
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Are you paying with your trust account?
❑ Yes ,&No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: i Single Family Detac ed ❑ Condo/townhome (single family attached) El Duplex
(j 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 ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
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
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: L / 1fL� oy' to ignature Date 7 -11-1 Y