HomeMy WebLinkAbout1630 Riverside Ave - Applications/Reroof - 08/28/2015Ciof
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 #.
For office use only
Date R - -8 - ZD/ S
lob Site Address required)
Jalue of Construction (labor, materials, profit)
Prop�.e,.rty Owner Name Address
City/State Zip Phone
Sldv� D JTr b x Z7o875,
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_Appkant Nam Address
City/State Zip Phone
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8o L6 F6 S ale —
Contractor Address
City/State Zip Phone
r?o J1�12P1' $G' 4
r �'Ql 90007 a3• G6- "ge
Co tractor City of A Collins Sales Tax #
Are you paying (axes here or by report? KHere ❑ Report
sales tax number is reguiredby�allcontractors
Are you paying with your trust account? ❑ Yes �lo
Is this a residential or commercial project? ❑ Residential Xcommercial
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 offs 0 Office ❑ Retail
El Restaurant Other (exp�lain)�, a o
Is this building 50 years of age or more? El Yes X'^'�" If yes, you may need to chniact Historic Reservation
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.
ption
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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 #
Mechanical Roofer - O Other
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: —�
Print Name: Phi n
Date 9-a-7 6L