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HomeMy WebLinkAbout233 3rd St - Applications/Reroof - 08/15/2018(;t^wC)t- 4 13s_�_ City of Planning, Development, & Transportation Services Fort 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). ❑ 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 # C)lU te �3_z�) Date For office use only ' ckT CP .7` ap— lob Site Address (required) Value of Construction (labor, materials, profit) 3,33 3�" rkk:" r4L 4sosa.Ll 3::3-70y-01q`f Property Owner Name Address City/State Zip Phone LA�-),r . ooveSZ a33 31 e ^,,k+ Fc 5-O.Sd14 3Oa-70r- ©! I Applicant Name Address City/State Zip Phone i c,G t( i`1,LL5a SKl0 C�A.L &,OStf C,^LLt L'Z cL4 'i 5 `j7o s73 014 Contractor Address City/State Zip Phone QlV 14Nt- P-,,Finsalo CA," L 3uni G^r i Go 970- 573- of `l Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? N Here ❑ Report sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential o ommercial project? ❑ Residential ❑ 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 may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work -ref LA,o Ld c. u,t A "L" on ,0 ro ,A I vi s � s *If lawn sprinkler/bac ow 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 # D 1 , Electrician Plumber Mechanical Roofer r�4 CAA`yo,,O 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: f ,-/S_-lC� Print Name: f l , j� Signature Ak Date TJ Revision date 2/6/2017