HomeMy WebLinkAbout1809 LAPORTE AVE - APPLICATIONS - 3/14/2018 (5)Cothns
Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fax 970.224.6134
OVEN -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 formation on Ion.
ap complete applications will not be accepted.
Application # Ir Date
For trr
VJobb Address (repulsed) Value of Construction (labor, materials, p�r� C t'Owner ame Address Qty/State Zip Phone
Name Address City/State Zip Phone
T-C 4-- C 611 4 I (O JV. c tic, e Lrn,Aa Lr
Contractor Address Qty/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ -o Report
�est"nur"�isr�/'ed/n'�/��rs aAre you Paying with your trust account? ❑ Yes �ry�
Is this a residential or commercial project? - Resddentlal ❑ Commercial
If residential, is it: �Ie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
uitlfamity (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ I '
Restaurant ❑ Other (explain)
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Is this [wilding 50 years of age or more? ❑ Yes ❑ No If yes you may waled to contactH&frwc p son
If this is for a demolition permit, what year was the building constructed?
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work 2 o I t
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n aa9_ Q to l o lI c O Ce/bacidlow preventer, must list licensed plu ber. If first-time A/C, must list liceb§ed electrici an L&t the compairy name or aty ofFr Co//!ns //tense 0
Plumber Medhaniol Roofer Other
I hereby acknowledge that I have read this application and state that the above information Is complete and correct I agree to
eomptY 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.
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Print Na a 1 M \1 i O/UL✓ Signature
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