HomeMy WebLinkAbout3112 Sweeney St - Applications/Reroof - 09/25/2017Fort of
Planning, Development & Transportation
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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ' ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ 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 #___ b1-11D UQS 1 Date
For office use only
9-ZS--2o it
Job Site Address (required)
54`
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address City/State Zip
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Phone
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Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
XHere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
VYes ❑ No
Is this a residential or commercial project? ,eResidential ❑ Commercial
If residential, is it: )a Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit wiM this application.
work
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*If lawn sprinkler/backflow preventer, must list licensed plumber
first-time A/C,
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber
❑ Duplex
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must list licensed electrician.
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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 law egulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: &"i�_a"_191rsignature
Print Nam Date 9 ZS —26 1�