HomeMy WebLinkAbout1767 Deweese St - Applications/Reroof - 10/31/2017/FCity of Planning, Development, & Transportation Services
� t CollinslCommunity 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 W'Koofing ❑ 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 #_ ip n O-I P4 Date 16 f i�
For office use only _
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
" -1 - z -Zsz
Appli t Name Address City/State Zip Phone
Contractor Address Gty/State Zip Phone
Contractor City of Ft Collins tales 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 co ;nercial proleco 5;'�esidential ❑ Commercial
If residential, is it OrSingle 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 morel ❑ Yes IWNo Ifyes, you mayneed to contact HislorrC Preservation
If this is for a demolition permit, what year was the building constructed - n I
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 Gty of Ft Collins license # I
Electrician Plumber Mechanical
Other
I hereby acknowledge that I have read this application and state that the above information is complete an 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: Iy
Print Name ll tL Signature Date
R.s.on date Z 2017