HomeMy WebLinkAbout604 LOUISE LN - APPLICATIONS - 6/22/2012Fort 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)1 oir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
,Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltadc
❑ 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 #I
For afte use oi*
Job Site Address (required)
Value of Constructiorn,(labor, materials, profit)
L
Property Owner. Name Address.
City/State 25p
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Tip
Phone
Nick
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
0 Report
Sales tax nurrrberBregLmW.Dyaff ow&adars
Are you paying with your trust account? XYes
El No .
Is this a residential or commercial project? residential ❑ Commercial
If residential; Is it: Ingle Family Detached ❑ Condo/townhome (stogie family attached) ❑ Duplex
LrMuldfamily (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 IZI No If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
Ifpnar to 1975, you wl//.need an asbesio:s assessment to submit with this appGedon.
Description of work
lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:
:�LIst the company name or Gty of R Collins Ikkense ,0'
Electrlcian_��M" umber. 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: ` kLo\_ 17r�Q � Signature 4�6L�. - �..— Date
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