HomeMy WebLinkAbout921 LAPORTE AVE - APPLICATIONS - 10/15/201810/15/2018 2:41PM FAX 8704844373
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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 bu used to apply for the following only (check all that apply), t7 Air Conditioning
Cl Demolition (interior non-structural) d Electrical Alteration (not service change) ❑ Gas Lighter) ❑ Gas Log
.I�Heating unit El Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 9,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 beiaccepted.
Application # U Date!005/6,
For ofline use only
Job Site Address (regwred)92) W0KWA FpY{ 01tL Value of Construction (labor, materials, profs )ODq.0D
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Property Ow;jr Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor Address City/State zl Phone
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Contractor Cityof Ft. Collins Sales Tax #
Are you paying taxes here or by report? i❑ Here (yY Report
Sales1axnumber Isrequiredbyall contractom Are you paying with your trust account? 7 Yes d No
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Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: K Single Family Detached ❑ Condo/townhome (single family attached) ❑iDuplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar U Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail
❑ Restaurant Cl Other (explain)
Is this building 50 years of age or more? Cl Yes Flo 1(yes, you mayneed to contact Historic P�eservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will nrjed an asbestos assessment to submit with this aoolisation.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors; Ust the company name or City of FtColllnslicense 0
lnectridan _ Plumber MecheniCal Roarer Other
1 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 construcition. I know that a
permit is not valid until it has been paid and Issued.
Applicant:
Print Name: Hts l�� A.uki Signature Date
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