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HomeMy WebLinkAbout1022 Laporte Ave - Applications/Reroof - 07/17/2017City of Planning, Development, & Transportation Services Fort Collins Community Development & Neighborhood Services `f 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�i Application # b 170 q /3 Date -7 —/ i r/ % For office use only Job Site Address (required) Value of Construction (labor, materials, profit) O as �� 16 Property Owner Name Address City/State Zip Phone )qrA?P Id // Applicant Name Address City/State Zip . Phone ✓; e -i 1 Cr� C",o�np�act Address City/State Zip Phone It r-p- 2C'ANw_, 3) 45 �ou q P14 Contractor City of Ft. CollW Sales Tax # J Are you paying taxes here or by report? ❑ Here ❑ Report Sales tax number isrequired byall contractors jR 7 /� q Are you paying with your trust account? ❑ Yes ❑ No Is this a residential o commercial project? Residential ❑ Commercial If residential, is it: Single Family Deta ed ❑ 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 Historic Preservation If this is for a demolition permit, what year was the building constructed? DescripAion of work PvoE7n e rn e ro neS i a" zjfr/c *If lawn ink er/backflow preventer, must list licensed plu r. If first-time A/ , mu6t list 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. y Applicant: -7 1(- Print Name: Signature © Date / Revision dale 202017