HomeMy WebLinkAbout622 W LAUREL ST - APPLICATIONS - 1/23/201901/28/2019 10:13 9703539774 I PAGE 01/02
forof
t Collins
/1*0 .
Planning, Development & Transportation
281 N. College Ave RO. 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 13 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.
#k 0 )t Application eq ml(( n Date 1-23-2019
Farms only
Job Site Address (requlmd)
Value of Construction (labor, materials, profit)
622 Laurel Street
6,000.00
1story
Property Owner Name Address
City/State Zip
Phone
Moses Horner 900 W. Mountain Ave Ft. Collins 80521
Applicant Name Address
City/State Zip
Phone
Kaleb Kramer 40522nd St.,
Greeley, CO 80631
970-405-2502
Contractor Address
City/State lap
Phone
Inde endent oo Inc. Same
970-363-1389
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
M Here ❑ Report
saes raxnumtrer/srequnrdeyanconnaaws.
Are you paying with your trust account?
M Yes ❑ No
Is this a residential or commercial project? Gtl Residential ❑ Commercial
If residential, is it: IB Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar Cl Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes 1XNo If yes,, you may need to contact HisloricPreservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you w/11 need an asbestos asRmwnent to submit with this application.
Description of work Tear off to deck, install drip edge, ice guard at eaves, 30 Ib. felt, valley tin,
*If lawn sprinlder/backRow preventer, must list licensed-ptumber. If first-time A/C, must fist licensed electrician.
Subcontractors., List the company name orCity ofprCo11/nsl/censeg Mayitos Rooting
Electrician Plumber Mechanical Roofer R294 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 taws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Appllcantr
Print fame:.TARI_Krarner Signature riMyKrcavvier Date Jan 23 2019