HomeMy WebLinkAbout2542 Newport Dr - Applications/Reroof - 10/27/2017City of 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
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. 1lQ S
Application # R 1_�6gl41(a
For office use only
Date )0- a,1- 3\o11
t 1� S0
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
SL>54o -Talo,n 7 iK" 354a. A->Vo 70- 93- yqE;
Applicant Name Address City/State Zip Phone
k4'c,,kA,t L_ 1 �'a,10 Get.0 g� C„tl� "�L/ 2�fJS3 ct 0.573-01`i
Contractor Address City/State Zip Phone
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10(0_.4 J F-q3I� 573J6 Ga.,. L & L,,-%,4 1~ e053g g7o • 5-7 3 - O t
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Eviere ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or c mmercial project? Residential ❑ Commercial
If residential, is it: CySingle 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 mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Descri tion of work �ti rQoF, +%-4, (ji' v5, P 7 �byN.��ts��r L �+ti e �J -Z �
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1�3rcvrtrun_. iT0 1� GL4ss '/ S>)t,�' Si!7-4 5�� . 3r I sat>an�s
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A.1/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer 4t,4_ V �J 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:
PrintName:'M#cl, e_ Yl (mod SignatureIJZL\Date
Revision date 2/6/2017