HomeMy WebLinkAbout2518 Newport Dr - Applications/Reroof - 09/07/2017Planning, Development & Transportation ^�
281 N. College Ave P.O. Box 580 p(
Fort Collins, CO 80524 .
Phone 970-416-2740 Fax 224-6I34 lcij. o
OVER-THE-COUNTER PERMITS ONLY V I Zvi
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conddi g
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
41
❑ Heating Unit ❑ Levin Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voRaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pelist Stove (must be EPA certified, provide make, model andac
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # I T 6 sm Date—
rar office use cnly
job Site Address (required)
Value of Construction (labor, materials, profit)
SIt + a-,. FIC S652-0 �
party O er Name Address
City/state Zip 75 e �
8
a6�
Applicant Name Address
�Y/� Zip Phone
VJiAd�,C %55D &I 9
Contractor Address
E IeViev�n;t
CRY/state Zip Phone
218 �l o PA g70-336-0LL3
Contractor City of Ft. Collins sales Tax
Are you paying taxes here or by report? Here ❑ Report
Are you paying with your bust account? ❑ Yes >(No
sales rernumber&requriedbyaucwmacmrs
Is this a residential or commercial project? ❑ Residential ❑ Commercial
if residential, is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Dupiex
❑ Multifamily (apartment) ❑ Garage
If commercial, is re ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Reid
❑ Restaurant ❑ Other (expla n)
Is this building 50 years of age or more? ❑ Yes No If yen, ynu may need to contact HL#wtc Prewwbw
If this Is for a demolition permit, what year was the budding constructed?
Ifprtor to 1975, you wIl need an asbestos a-4wmm nt to submd w1th this applkahon.
xV lawn sprinider/bacidlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subeont actere: L&t the cmnpany name or Giy offt Co// w11crose 0 g — ; i43
Electrician Plumbs MerhanlcW Room i2—)C Other
I hereby acknowledge that I haw: read this application and state that the above Information is complete and correct. I agree to
comply wroth an requirements contained herein and city ordinances and state laws regulating building consbactim. I know that a
permit is not valid until it has been paid and issued•\)
ApPlirant:
Print Nam
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