HomeMy WebLinkAbout1724 Valley Forge Ave - Applications/Reroof - 11/01/2017City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
Ic — 281 North College AvenuR
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 5koofing ❑ 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.
Application # Z) 1-1 013t
C ' nff"ro „e nnry
Incomplete applications will not be accepted.
Date Il
Job Site Ad ress (required) Value of Construction (labor, materials, profit)i
Property Owner Namek
Address City State Ziqp��// Phone;
Applicant Nam Addr s City/State Zip Phone',
�051(h o
Contractor Address City/State Zip Phone
�-z57
r �
Contractor City of Ft. Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑Report
with your trust account? ❑ Yes ❑INo
sales tax number is required by all contractors. Are you paying
Is this a residential or com erdal project? esidentiai ❑ Commercial
Detached ❑ Condo/townhome (single family attached) ❑ Duplex
If residential, is it: ingle Family
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑Medical office ❑10ffice ❑Retail
❑ Restaurant ❑Other (explai-------------
Is this building So years of age or more? ❑ Yes o If yes, you may need la contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
C
Description of work
I'
*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 #
Electrician Plumber Mechanical Roofe Other
I hereby acknowledge that I have read this application and state that the above information is complete an correct. I agree to
laws regulating building construction. I know,that a
comply with all requirements contained herein and city ordinances and state
permit is not valid until it has been paid and issued.
Applicant: Date 1'
Print Name: Signature
R.v Iiln dW. 2MM17