HomeMy WebLinkAbout137 Mathews St - Applications/Reroof - 05/13/2013CityOf Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins 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 ❑ 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.
Application # I31)'Q@L ' Date 5- 13
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
1-3-7 — 14-'�) YYlaiKew S (fb i l rye 1 $ 1 6coai
Property Owner Name
Address City/State Zip Phone
fG&S- lT errs el -Hes
I1 -F)r1r fir. t- mums CO & 5Z-Ss R7o a,4 i
ADDlicant Name
Address City/State Zip Phone
SP.t' `il�i $r>°ct at`�prlve , b=t Cz�llrvts CD BtiSZ�(q-7 7J�1-I&T
Contra r Lic #
Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report? ❑ Here f�jeport
sales tax number isrequiredbyall contractors.
Are you paying with your trust account? ❑ Yes - o
Is this a residential or commercial project? 0 Res�id�'tial ❑ Commercial
If residential, is it: ❑ Single Family Detached LgCondo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? GrYes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with th/s application.
Description of work ke'YVIP—
L
sprinkler/backflow preventer, must list licensed plumber. Iff lst-time A/C, must list licensed electrician. (:( V
Subcontractors: List the company name or City of Ft Collins license # A=4nWd
Electrician Plumber Mechanical
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: ��` "�P� Signature