HomeMy WebLinkAbout2225 Suffolk St - Applications/Reroof - 10/12/2017City of Planning, Development, & Transportation Services
�F�t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970224.6134
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 # V n 13U S a�
For office use only
Date IC1a-n
Job Site Address (required) Value of Construction (labor, materials, profit)
aaaS Ik :4. PoC-1 vSa O SI — 3 1
Property Owner Name Address City/State Zip Phone
b&T'C.l G« SG f"le-
Applica4 Name U Address City/State Zip Phone
Contractor Address City/State Zip Phone
oC-� 1 �r3 FieS�u� "i S S- , e Layt&614,[IL)al-nocri
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all conbadom Are you paying with your trust account? 18 Yes ❑ No
Is this a residential or commercial project? V Residential ❑ Commercial
If residential, is it: I@ 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 Preservadon
If this is for a demolition permit, what year was the building constructed?
Description of work RUnove 0,6 REfic `e_ 11,64 niaezirx C rsn'A5 T1,Cl:4,io,,
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orGly of Collins license #
Electrician Plumber 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 laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Signature Date
RaWsim data 21W017