HomeMy WebLinkAbout3339 W Prospect Rd - Applications/Reroof - 06/27/2017City 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-voftaic
❑ ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable Information ontheapplication. Incomplete applications will not
be accepted
Application # B k-1 0 35o�f Date �Iz -7
For ofTiae use only
Job Site Address (iequlied) Value of Construction (labor, materials, profit /
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Property Owner Name Address City/State Zip 202) Phone
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Applicant Name Address City/State Zip Q9p Phone
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CLoAddress City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here .bIeport
Sales bur number Is requued by all cwrbadors Are you paying with your trust account? ❑ Yes "o
Is this a residential or commercial projects Residential ❑ Commercial
If residential, is it: 'Wingle 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 budding 50 yearsof age or morel ❑ Yes ❑ No If yes, you may need to contact Hatonc Presiemabon
If this Is for a demolition permit, what year was the building constructed?
Description of work
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*If lawn spnnkler/back low preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: tuf the company name or City of Ft Coffins bosnse #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above informabon is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating budding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant,,,�GE�•� l� L
Print Name ; �S ;Signature Date 62 7 /
ReWsm date 2W01 r