HomeMy WebLinkAbout2449 W Stuart St - Applications/Reroof - 10/19/2017'.F6eCitvof Planning, Development, & Transportation Services
t� 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 El Lawn Sprinkler ❑ Mobile Home replacement 5;' oofiing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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 0 1(Q q3� Date _ ��Ira
For office use only --�— r
lob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
,NNtt�n� rvarne Address City/State Zip Phone
Contractor Address City/State Zip Phone
? I r,
Contractor City of Ft. Collins kiles Tax
Sales tax number is required by all contractors
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? VResidential ❑ Commercial
If residential, is it: Dingle 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 (explai
Is this building 50 years of age or more? ❑Yes WINO If yes, you may need to contact Historic Preservation v
If this is for a demolition permit, what year was the building constructed?
of work
*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 # A n
Electrician Plumber Mechanical
Other
I hereby acknowledge that I have read this application and state that the above information is comTconstruction.
andagree to
comply with all requirements contained herein and city ordinances and state laws regulating buildinow that a
permit is not valid until it has been paid and issued.
i
Applicant: ,��n _Print Name: A Signature4;
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Revision date 26Q017