HomeMy WebLinkAbout950 LAPORTE AVE - APPLICATIONS - 7/16/2018Fiy fit Pfanning, Development, & Transportation Services
. z:— Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 19 oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all tpplibl f at..iifn tl , apup
ication
Application # upp U
For office use only
Incomplete applications will not be accepted.
Date 7 /6 20 / I
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Job Site Address (required) I Value of Construction (labor, materials, rofit)
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Property pwner N me Address/State Zip Phone
Applicant Name Address City/State Zip Phone
'tx& 5-z-1 �_i) Z44
Contractor Address City/State Zip Phone
Z57-
Contractor City of Ft. Collins 4es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
s Stax number isrequiredayall mntracmrs. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or comp ercial project? esidential ❑ Commercial
If residential, is it: ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail e 7 L _
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? OYeswNo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work i!16 3/. -,"r^ C F
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must,/IIstt licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # - 1?W;
Electrician 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: &K Signature Date ';f1t
V \ \
Revmon date M11017 V
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