HomeMy WebLinkAbout3202 Grand Canyon St - Applications/Reroof - 10/01/2014Fort of
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 ❑ 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 # itJl -` 1? f CZ'( Date M
Fbr ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
3a09 &(-ccricQ CccoyoKi St
91000
Property Owner Name Address
City/State Zip Phone
1,`,,en TaG%sdn 3a0a G-nar)d Cariyon S� Fe dollmns Co 96595 `T70-566-0711
Applicant Name Address
City/State Zip Phone
�Tona*ao MaX-Dell 18(d Rcf(ln9to0 3E. rt eolfons Co 805a5 303-y10-0g5'T
Contractor Address
City/State Zip Phone
Cooper Con6+rytcd6r 7/1 18/a Rec4rn34on
SE RebllfnS CO 805015 303-qy0 -085`?
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? X Here ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ANo
Is this a resideritial or commercial project? >Zt Residential ❑ Commercial
If residential, is it: 11single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
❑ Duplex
❑ Retail
Is this building 50 years of age or more? ❑ Yes A 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 applicatlon.
Description of work
a- Shrug le
as SO 0? 5+0ry
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the comnanv name or City of Ft t-nll/ns license #
Electrician Plumber.
L COVCr".
Mechanical Roofer Ear 1 C on5 6 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: �(iGCTr kcl�i l lQ)(iie(G�
Print Name: Signature
Date 01111`