HomeMy WebLinkAbout615 S LOOMIS AVE - APPLICATIONS - 9/15/2016Plzmdhq, Deveiopnient & frarsportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 805211
'_J 1 t
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). LJ Air Conditioning
❑ Den,oiltion (interior non-structural) ElElectrical Alteration (not service change) ❑ Gas Lighter ❑Gas Log
Cl lJe ,ti;,g Ul;fta, ❑ Lai^n, Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 venblation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA cartifed, provide make, modal and
i11aI ;UiaCtUrel-).
Colnplote all applicable in )rnat'or�oin -the application. Incorro�9eze ap�licat3ons L/vil? no/t-be accepted.
W v /5-
1,3Date
Application #_ � use Only -
Sob Site Address (/zguiiz 'value of Construction (labor, materials, profit)
D�� t '�. -611 - -
r U L Owner Nal„�� d75 5- ver bets/SC Zip 1A.0_ Phone
W I
'non VAI ' Irk
Phone
#,Dl�)I'
ant Name A -ass City/State Zip
Contractor. Address City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #;< Are you paying taxes here or by report?
Are you paying with your trust account?
❑ Hare 'c�Report
'yYes ❑ NO
:Jes ca.t r2cunborisraguiiedbyall contractors
i
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single Family attached) '1 Duplex
❑ Multifamily (apartment) ❑ Garage
I;'cornmercial, is it: ElBank ❑ Bar ❑.Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑Retail
❑ Restaurant ❑ Other (explain) -----
Is this building 50 years of aga or more? ❑ Yes ❑ No If yes, you mayrjeed to contact Histoirc/'reservation
if this is for a detnolition perrnFt, what year was the building constructed? __—
f c /i %l to 1975, you l-viil need an asbestos assessment to submit with this application. —
Description of work
:';Ii. lawn sl�rini<It'_,- ackflow preventer, must- list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/stthe con 1-)anynameorCityofFtCoii/.nsiicensenf
FI•:�tricia,i--_-.-- ?lumber_ Mechanical — Roofer_— --- .-- Other
f hereby acla;owledga 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 t:orlsVILICUoli. I J(noi-1ti,at a
pernnit is not valid unfits it leas been paid and issued.
Applicant. + l Signature NasmeTO. y)te,---
_