HomeMy WebLinkAbout1148 LAPORTE AVE - APPLICATIONS - 10/31/2017=ztr c Planning, Deveioproacent, & Transportation Services
For"t Collins Community Development & Neighborhood Services
281 Noith College Avenue
Fort Collins. CO 80524 Main: 970A16.2740 Fax: 970.224.6134
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-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ 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 # 6 r] 0-133co Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profi Rom'• -
Property Owner Name Address City/State Tip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Sales tax number is mqufred by all cvntradom Are you paying With your trust account? X Yes ❑ NO
Is this a residential or commercial project? MResidential ❑ Commercial
If residential, is it: -USingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of workG_r�2 5
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*If 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 ft Collins license #
Electrician 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. ��i
Print Name:—' illy Signature _ Date
Revision date 21 =?