HomeMy WebLinkAbout2457 Compass Ct - Applications/Reroof - 09/15/2017Cityof Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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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 Elt� Mobile Home replacement I 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 information on the application. Incomplete applications will not be accepted.
Application # b M 555ro Date q 15- 1`7
For office use only
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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Applica t Name Address OF City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Oes 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? ❑ Yes ❑ No
Is this a residential or com�ercial project? esidential ❑ Commercial
If residential, is it: M'Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage I
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ElYesMINo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work `G a
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # f/y'
Electrician Plumber Mechanical RooferaA M 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 building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: Iy /
Print Name: l l Signature Date — /
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Rovision date 2/612017