HomeMy WebLinkAbout2237 Smallwood Dr - Applications/Reroof - 11/10/2014Cityof Planning, Development & Transportation
{ 281 N. College Ave P.O. Box 580
FOrI Cos Fort Collins, CO 80524
Phone 970-41616-2740 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 # 251A-I 1 J,,0I_ Date Id
For office, use only
Job Site Address (required)
'(bins
Value of Construction (labor, materials, profit)
37 Srunclwood �r �A 0d
$b5 j� IS 0
1i
Property Owner Name Address
City/State Zip
Phone
Y�_ J(01— 31 Svv�l o� Dr
<<i'm Q ytgy
5910
Applicad Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
S criftenie, Av-P
HColliksCo . 0
3 5c�
Contractor City of Ft. Ilins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
sales tax n3u rjsrequi_ Qbyall contractors. Are you paying with your trust account?
❑ Yes 0 No
Is this a residential or c mmercial project? Allesidential ❑ 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 )Q No If yes, you mayneed 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
*If lawn sprinkler/backflow prevente?, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cly of Ft Collins license # n �►p
Mechanical Roofer7' �6� r �"ther
Electrician Plumber.
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: r �J
Print Name: a17� \ �ftl� )10Z Signature Date It (D /1