HomeMy WebLinkAbout615 W LAKE ST - APPLICATIONS - 7/30/2015Jul28 1501:17p Hahn plumbing
970-493-5325 p.1
City OT
Fbrt C> Wns
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).NLAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas lighter ❑ Gas Log
KIleating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line. ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 11505 70 q Date 7 -]10 -IS
For orirce use a*
Job Site Address (required)
Value of Construction (labor. materials, profit)
Property Owner Name Address
l/
city/state Zip
Phone
r D
3
Name. Address
Citylstate Zip
Phone
)Applicant
J
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Contractor j Address
City/State Zip
Phone
147f h, J'.l. l7'Q jj
Contractor City of Ft. Collins 5 4 s Tax ; rYl P- / 5-
Are you paying taxes here or by report? 0 Here
XR,eport
Sala5 tax number is required by allcon6actars.
Are you paying with your trust account? gYes
❑ No
! 60 1� •7 Cl
Is this a residential orK7svllultifamlly
mercial project? gResidendal ❑ Commercial
If residential, is it: ngle Family Detached ❑ Condo/townhome (single family attached) - • ❑ Duplex
(apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church El Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Ci No If yes, you mayneed to contact HistoricPreseivation
If this is for a demolition permit, what year was the building constructed?
fprlor to 1975, you will need an asbestos assessment to submit with this application.
Descriptlan of work
"'If lawn sprinkler/badviow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the company name orO'ty of Ft Collins license #
Electrician PlumLer 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
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