HomeMy WebLinkAbout221 E Swallow Rd - Applications/Reroof - 08/13/2014Fort Collins
Planning, Development`& Transportation
281 N. College Ave P.O. Box 580
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 )Q 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 # 'b 1`f 0,7qq 6
For office use only
Date 'S>J f 3 oi'
Job Site Address (required)
Value of Construction (labor, materials, profit)
o
, I
—2,0 C)
Property Owner Name
. Address
City/State Zip Phone
Cn wi lalti4n Z21
L S�W
(2�, �r Cd.1�/ %-S C,>
Applicant Name
Address
City/State Zip Phone
amp l
c 5',Jcu0ow
Contractor
Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? L. Residential ❑ Commercial
If residential, is it: K Single 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 'JkNo Ifyes, 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
s;
*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
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: 0-1 At,' -It d ULaiAj( Signature Date