HomeMy WebLinkAbout518 N Loomis Ave - Applications/Reroof - 10/10/2016City ®$
Fort Collins
.1..
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 # I(to Date A Co 24,/
For olpce use only
Sob Site Address (required)
O m IS Value of Construction (labor, materials, profit)
o -
.
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address City/State Zip
Phone
&C l
z_Zzl 1311—
CD
Contractor
Address
City/State Zip
Phone
T�ga(iq—
` -'S "ie" 'g—
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial 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 XOther (explain) G fFf2&Et. W,c,F_
Is this building 50 years of age or more? ❑ Yes J�r_N o If yes, you may need to contact Historic Preservation
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.
of work kxiS-7n16 `LSC4
",
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list IiEensed electrician.
Subcontractors: List the company name or City of Ft Collins license # 2 i- S��L(S �yi G7 � g 1,�/ j in
J
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. A
Applicant:
Print Name:
Date , 4