HomeMy WebLinkAbout430 LAPORTE AVE - APPLICATIONS - 9/13/2018City of
�F.�or_t 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). ❑ 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 onn�the
`application. Incomplete applications will not be accepted.`,
Application # � � � o %'7 Date l f ) �> / l 8 b
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit) �J
Property Owner Name
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Address
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City/State
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Zip
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Phone
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Applicant Name/
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Address
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City/State
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Zip
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Address
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City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report?Here
❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? Z Residential ❑ Commercial �
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) 63'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 Ifyes, you mayneed to contact Historic Preservation
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
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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 City of Ft Collins license #
Electrician t- 14 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 Name: ?1 1 11 L UtGGtt7� J� 1� Signaty e Date
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