HomeMy WebLinkAbout632 S LOOMIS AVE - APPLICATIONS - 5/18/2018May 18 2018 05 OOPM HP Fax 9706130826 page 1
.--IN
FCityaf Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Semces
281 North Co" Avenue
Fort Collins, CO 80524 Main 970 4162740 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 sermoe change) ❑ Gas Lighter ❑ Gas Log
1A Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voitalc
❑ 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 #_ Nq Date 5119117
For of e use oNy
Sob Site Address (regwred) Value of Construction (labor, materials, profit)
L94 SD
Property Owner Name Address City/State Zip Phone
S 3
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City o Collins Sales Tax # Are you paying taxes here or by report? J Here ❑ Report
saLstax I%MbwIsrwuhvdbyau�noacibm Are you paying with your trust accounts Yes ❑ No
Is this a residential or commercial project? EJ Residential ❑ Commercial
If residential, is it Single Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
Mulbfamlly (apartment) ❑ Garage
If commercial, is It ❑ Bank ❑ Bar ❑ Church ❑ HoteVMotel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or morel C3Y No If yes, yew may need to contact ffswlyc Preservaban
If this is for a demolition permit, what year was the building constructed?
Description of work FUQnq(k R=(�,1'Y1� Alf:
09 0% Qt �nU _
*If lawn sprinkler/bacCFlow preventer, must Ist licensed plumber If first-time A/C, must list licensed electrician
Subcontractors L& the company name oray), of t Collins Areaw 0
Elecbldan 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 untki It has been paid and Issued
Lama
(gyp L_ �'-�-� -
PrInit alit LWJ�n,,,, A �. IODMQ111�/�g
Print Name ��Vate
JIAUJAMEMp
Revimen dde 2V2017