HomeMy WebLinkAbout1618 Silvergate Rd - Applications/Reroof - 04/14/2014Cityof Planning, Development & Transportation
} 281 N. College Ave P.O. Box 580
Fir` 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.
Application # J� I u o / 1-5 0
For office use only
Incomplete applications will not be accepted.
Date 4- iq-t4
Job Site Address (required) Value of Construction (labor, materials, profit)
4 e a/k 4 $ 35'60.e4z
Property Owner Name
Address
City/State
Zip
Phone
o lllSorl /b
.S /ve
ale 1�
BOS24 f afoa
Applicant Name
Address
City/State
Zip
Phone
2 fd Davis
o
ef::% M Co
806_2
z.zc - 12.8 r
Contractor Lic #
Address
City/State
Zip
Phone
30to
c
9oszq
zxi -(Lai
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
IWHere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
IllCYes ❑ No
Is this a residential or commercial project? I Residential ❑ Commercial
If residential, is it: ASingle Family Detached ❑ Condo/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? ❑ Yes III 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 this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Aratar Mother
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: �Q`C Q
Print Name: ;F"PJAJ Signature tea- Date