HomeMy WebLinkAbout2120 Vermont Dr - Applications/Reroof - 05/07/20151�
Fort 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 ❑ 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 Date
For ofce use only
Job Site Address (required)
alga Uarr►, Dr,
Value of Construction (labor, materials, profit)
13 Ss .3 SS
Property Owner Name Address
City/State Zip
Phone
r Glpr oil 310 N- co I
.Cgul%s CD
to 5 H�a
Applicant Name Address
City/State Zip
Phone
"L AunAs 110a5
+ - (Allihs, co 5J-S
q IT7 Soa
Contractor Address
City/State Zip
Phone
51LP {y� Ili 5 fiM
3 CDAI� a �,5
9�a��a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
M Here ❑ Report
sales tax number 8 rreouiredbyall contractors
Are you paying with your trust account?
19 Yes ❑ No
Is this a residential or commercial project? ❑ Residential P 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 IM Other (explain) Qds R iThyn - C ropy
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you w111 need an asbestos assessment to submit with this appl/cation. ® K I
5-6—
Description of workTen ry-W eylCil►lq M14rill roof inaftri.,l AY, nz).c.r*vf-nn, PAmAA1 Ail,* - u
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician. S&44A
Subcontractors: L/st the company name or City of Ft Collins license #
Electrician Plumber Mechanical +
Roofer al�-a 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: - Il
Print Name: S1 oi/t �}i'Gr gill Signature Date
15
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