HomeMy WebLinkAbout2444 Marquette St - Applications/Reroof - 06/12/2015Jun 121509:31a Tony
1-970-669-5999 p.1
Fort 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 #
For office use only
Date lQ / U/
lob Site Address (required)
Value of Construction (labor, materrials, profit)
'
C L
.3�
17 b�
Property Owner Name
Address
City/State Zip
Phone
>r Oln
E' .
3052.5
tao- U ;L
Applicant Name
Address
City/State Zip
Phone
Contractor J
Address
City/State Zip
Phone
Contractor City of Ft. Collins Salegiax #
Safes tax number la required byaffcontacrom
Are you paying with your trust account? *Yes ❑ No
Is this a residential or commercial project? N$ Residential ❑ Commercial
If residential, is it: 54 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ yotei/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? i] Yes D No Ifyes, you mayneed to confactHiston;c Preservai on
If this is for a demolition permit, what year was the building constr=ed?
Ifprior to 1975, you will need an asbastos assessment to submit with this application.
Description of
lawn sprinider/back low prevVnter, must list licensed flwnber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name cr Cty of FtColllnsllcense 9
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: d.! a'
Print Name: iu� Signa}nre Date
e