HomeMy WebLinkAbout2416 W Mulberry St - Applications/Reroof - 07/28/2017City of Planning, Development, & Transportation Services
Flirt 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 #1.-16 2:2,-,2N s Dated ,17
For office use only
lob Site Address (requ/red) Value of Construction (labor, materials, profit)
Property Owner Name Address ity/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number Isrequredbyall contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it. 19 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 ❑ No If yes, you may need to contact Histonc Preservahon
If this is for a demolition permit, what year was the building constructed?
Description of work `
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*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must I st licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
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.
Applicant: 1 , -
PrntName MfiRI iA-�90-RU�S 1 signature4sDate � i)
Rewvw date 2ro/2017