HomeMy WebLinkAbout116 Smokey St - Applications/Reroof - 05/12/2016city, of Planning, Development & Transportation
2B1 N. College Ave P.O.'Box 580
fort Collins 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 w ill not be accepted.
Application #� Date
' For office use only
Job Site Address Mequlred)
Value of Construction (labor, materials, profit)
11 " ' e
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Property Owner Name
Address
City/State Zip Phone
Applicant Name
Address
City/State Zip Phone
Po Box 1326
Ft. Collins 80522 9705661884
Contractor
Address
City/State Zip Phone
Ticos Roofing Inc
Po Box 1326
Ft. Collins 80522 9705661884
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? M Here Q Report
sales emnumber isrequlmdbyall contracrors
Are you paying with your trust account? ❑ Yes ❑ No
R-1686 .'
Is this a residential or commercial project? L9 Residential ❑ Commercial
If residential, is it: ®Single Family Detached ' ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: D Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 13 Other (explain)
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?
rpn'or to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinkler/backfiow 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 #
Electridan Plumber Mechanical , Roofer R-1686 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: r
Print Name Signatur �\ � ®ate _y
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