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HomeMy WebLinkAbout1918 Overlook Dr - Applications/Reroof - 09/01/2017Planning, Development & Transportation City of 281 N. College Ave P 0 Box 580 e- t Collins Fort Collins, CO8052 Phone 970-412740 Fax 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 §44toofing ❑ 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 onthe application Application # I r05.1141 . For office use only Incomplete applications will not be accepted Date Job Site Address (requirled)) Value of Construction (labor, materials, profit) 00 1� _ lQ� l%v�lil�9 tdt C© Jr—Jr� Property Owner Name Address S Igcl City/State Zip Phone Ovr.(lcoL�r CoJIIt�SCe� Sr,S 4s 28 Applicant Name Address City/State Zip Phone 0(rl o (o2S Sr LoLLLsApe- (.7 k3l TO DDO Contractor Address City/State Zip Phone t02 a4ta CZ a)53 R7OLtql `CIO Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? V Here ❑ Report Sales tax number is required by all contractors Are you paying with your trust account? P'Yes ❑No Is this a residential or commercial project? El Residenbal ❑ Commercial If residential, is it 0 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 SO yearsof age or more? O Yes ❑ No If yes, you may need to contact Histonc Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application Of *If lawn sprinkler/backflow preventer, must list licensed plumber If first-time`A/C, must list licensed electrician Subcontractors: List the company name or Qty of Ft Collins license # Electrician Plumber Mechanical Roofer K 2—•() 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 law egulating building construction I know that a permit is not valid unbl it has been paid and issued. Applicant: �1 Print Nam • Signature Date