HomeMy WebLinkAbout813 Powderhorn Dr - Applications/Reroof - 09/25/2017City 0f Planning, Development & Transportation
I 281 N. College Ave P.O. Box 580
Fort Collins 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 # e Al Q ,';q9i) Date 2-!5- 20
For office use only
Job Site Ad ress (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name Address
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City/State Zip Phone
bl� f (V(OtKS OOV-05-240 R-702)gVW
Applicant Name Address City/State Zip 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? X Here ❑ 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? A Residential ❑ Commercial
If residential, is it: �n 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 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 pncr to 1975, you will need an asbestos assessment to submit with this application.
Description of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/ct must list licen, ed I ctrician. fJ
Subcontractors: List the company name or City of Ft Collins license # CJ . KOC y l 9 (k6"? i OAf�
Electrician Plumber Mechanical Roo et r r_'�"'+�'1 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: ,
Print Nam Signature Date ����/