HomeMy WebLinkAbout615 W LAKE ST - APPLICATIONS - 7/28/2015Jul28 1501:17p Hahn plumbing
970-493-5325 p.1
of
Flirt CoLlins
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).�j Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
KHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line . ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted.
Application #J3156570 (, Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
Cib//State Zlp
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Phone '
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Applicant Name
City/State Zip
Phone
yA�ddress
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Contractor j Address
Citylstate Zip
Phone
Contractor City of Ft. Collins 5 4 s Tax # r)'1 P— 15
Are you paying taxes here or by report? II Here
�<Repert
Sales my number is required by allcartiactom
Are you paying with your trust account? XYes
❑ No
- / In _n '3 59
Is this a residential or c mercial project? 9,Residenual ❑ Commercial
If residential, is it: ngle Family Detached ❑ Condoltownhome (single family attached) • • 17 Duplex
Multifamily (apartment) LI Garage
If commercial, !sit: Q Bank 0 8ar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Cl No if yes, youmayneed to contactHlslorrcPreservaiion
If this is for a demolition permit, what year was the building constructed?
if priorro 1975, you will need an asbestos assesr✓nent to submit with this applicadon.
Description of work
*If lawn sprinkler/bacMow preventer, must list licensed plumber. If first -lame A/C, must list licensed elech iclan.
Subcontractors: List filecompanynameorGtyorFtCollins lkwse
Electr9cian Plumber MedtarIcal 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. F know that a
permit is not valid until it has been paid and Issued.
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PrinApplicant:
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