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HomeMy WebLinkAbout615 W LAKE ST - APPLICATIONS - 6/19/2015Jun 19 1502:18p Hahn plumbing 970-493-5325 p.1 City of Port CoWns 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-struotural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log © Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer tine. Q Photo -voltaic Ventilation Water Heater ❑ Water Line El Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer . Complete all appilcable information on the application. Incomplete applications will not be accepted. Application # -615 G q -7S ((' For office use only Date?` — lob Site Address (recluiredj Value of Construction (labcK materials, profit) ccssr'EC'' L J Lq k e- �+U.117 Property Owner Name Address City/State Zip Phone ' Applicant Name Address City/State zip Phone to Contractor J Address Clty/State ZIP Phone .h Contractor City of Ft. Collins 5 Tax # r),t P-15 Are you paying taxes here or by report? 13 Here VReport Sales tar number Is required bbyall mnfraetois Are you paying witli your trust account? Yes ❑ Na 1 I is this a residential or mmeraal project? XResidentlal ❑ Commercial If residential, is it: Single Family Detached Q Cando/bownhome (single family attached) - . ❑ Duplex Multifamily (apartment) ❑ Garage If commercial, is It ❑ Bank ❑ Bar L7 Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail © Restaurant Cl Other (explain) Is this building 50 years of age or morel ❑ Yes ❑ No If yes, you mayneed to mnlactHstorlcPresevvaffon If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. Description of work 2 -p *If lawn sprinkler/bacMow preventer, must list licensed plumber. If first-time A/C, must list licensed elec riclan. Subcontractors: List the company name orCly ofRCollins lx-anse # 9zcaician 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 Nam