HomeMy WebLinkAbout2530 Newport Dr - Applications/Reroof - 09/06/2017FCltyof Planning, Development, & Transportation Services
art 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 5? oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable informab n on the ap�nlication Incomplete applications will not be accepted
Application #_ 1) 1 �`-' I`C
For Date
use only
lob Site Address (required) Value of Construction (labor, materials, profit)
Z5�p `�
Property Owner Nam Address City/State Zip Phone
ce 2 "� ft
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins es Tax 'I
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number rs requved by all mntracro s Are you paying with your trust accounts ❑ Yes ❑ No
Is this a residential or corn ercial projects esidential ❑Commercial
If residential, is rt mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ HoteVivotel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or morel ❑ Yes 19 O If yes, you may need to contactHistonc i rnf ervahon
If this is for a demolition permit, what year was the building constructed?
Description of work y 25
*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors, list the company name or Gty offt 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 regulabng budding construction I know that a
permit is not valid until it has been paid and issued.
Applicant
Print Name l.t, Signature47PEi�'\ Date
Rev I.n dale ZWIO17 V