HomeMy WebLinkAbout1906 Dorset Dr - Applications/Reroof - 09/14/2017City of a
Frt CoWns
Planning, Development & Transportation _-'? L-�
281 N. College Ave P.O. Box 580 (�
Fort Collins, CO 80524
Phone 970-416-2740 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 VUfi •
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ��
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltsic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model an
manufacturer).
Complete all applicable information on the application. Incomplete applications will /not be
accepted.
Application # E1-7d SSA Date
Fnr nffim rMOonly
lob Site Address (required)
vahm of Construction (labor aterials, profit)
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operty Owner Name
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Address .
City/State Zip Phone
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Applicant Name
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Address .
City/State Zip Phone—
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Contractor
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Address
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City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report? Here ❑ Report
Are you paying with your trust account? ❑ Yes )ZNo
-westrxnumberlsregairedbyall cW aMM
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Model ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (expla n)
Is this building So years of age or more? ❑ Yes No lfyes, you mayneed to cvntactHisio�fc Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975. you wr/I need an asba%ts assessment to submit with this application.
*If lawn sprinider/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subeontaetors: List the company name or OW of Ft Collins Abanse # �' ; H.3 Electrician plumber Mechanlad Roofer 12')C Other
Fherebyadcnowledge that I have read this application and state that the above Information is complete and correct. I agree to
quirements contained herein and city ordinances and state laws regulating building construction• I know drat a
lid until it has been paid and Issued. Data
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