HomeMy WebLinkAbout935 Pioneer Ave - Applications/Reroof - 08/18/2017ecCiityof Planning, Development, & Transportation Services
s—C®«��$ 6 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). CI Air Conditioning
• Oemolition (interior non-structural) U Electrical Alteration (not service change) 19 Gas Lighter ❑ Gas Log
CI Heating Unit CI Lawn Sprinkler a Mobile Home replacement ❑ Roofing Q Sewer Line Cl Photo -voltaic
❑ Ventilation ❑ Water Heater CJ Water Line Cl 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
For office use only
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip [48a- POW
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Contractor Add ss City/State Zip Phone
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Contractor City of R. 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? AYes ❑ No
Is this a residential oEcmmerclal project? Residential ❑ Commarclal
If residential, is itingle Family Detached Q Condo/towrhome (single family attached) ❑ Duplex
ulbfamdy (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 0 Other (explain)
is this building 50 years of age or morel ❑ Yes ❑ No If yes, you may need to contact Nistonc Preservation
If this is for a demolition permit, what year was the budding constructed?
Description of
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*If lawn spnnkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: List die company name or Cny 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 budding construction I know that a
permit is not valid until it has been paid and issued.
Applicant:O'd ph 1n
Print Name T� 1n i ��L Signature Date
Ravivon dale 21MW