HomeMy WebLinkAbout2157 Bock St - Applications/Reroof - 07/24/2018C,Ciityof Planning, Development, & Transportation Services q;jqo
Fokt Collins Community Development & Neighborhood Services
�✓ 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement .Roofing ❑ Sewer Line ❑ Photo -voltaic
El Ventilation 0 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 # 2 I vy S f V2�- Date
For oKrce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
i � 6 4 dock (0(�ins i (o SDr2)4 S 1100 -
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
�tAZYJU �,rtC+(41r1(1 U�S.L )leic'i�l� 1t,(ilnZ3-)--1SS:
Contractor Address City/State Zip Phone
,S6ver&WeLL4iler- L-),An S._(.OIIL C Ne,F2:,0'R.LzIlirl5 co riio-2L3-7-C%SS
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Saes ru number is requfrMaya#contractors. Are you paying with your trust account? ❑ Yes i;CNo
Is this a residential or mmercial project? %Residential ❑ Commercial
If residential, is it: A 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 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes F No If yes, you may need to contact Nistonc Preservation
If this is for a demolition permit, what year was the building constructed?
Descriptio of work _15M Ot 441711 t( � f 5 Y . IuCQ Wt (1 5 0
w s fn' f Du 'LO
*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 & -�(,`� .� yAAA��IIIt.+Yn1/1
Electridan Plumber Mechanical Roofer �l IJ '. 1�Y.'.' 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 r1until it has been paid
�and issued.
Applicant: nPt Name: l l I. t,liV I SO Signature Date
Rcnsun m* M7017