HomeMy WebLinkAbout2100 Stillwater Creek Dr - Applications/Reroof - 08/11/2014Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F.�ort Collins Fort Collins, CO 80524 j
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 I
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableinformationon the application. Incomplete applications will not be accepted.
Application # ` 057 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
a i oo a&we_
2
Property Owner Name Address
City/State Zip
Phone 0918
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Fr CO(•C_ t& (a 8C-6
`20-(082-
Applicant Name Address
City/State Zip
Phone
Contractor Address
Grclo.l City/State Zip
Phone
D'CBu►�oi? l2oorctit 1957 MMoos sr LAtccrwooi) Co ScQi Ll
3-4W-37y$
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? XHere ❑ Report
Sales tax number Isrequlredbyall contractors.
Are you paying with your trust account?
❑ Yes ❑ No j
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: 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 J2�No If yes, you may need to contactHistoric 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.
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Description of work te ^ a cJ a,., p
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*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 # �� [AAA Ln°Ai�N G
Electrician Plumber Mechanical Roofer Other
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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 thatla
permit Is not valid until It has been paid and issued.
Applicant: 1
Print Name: V y q j --J Signature Date
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