HomeMy WebLinkAbout2621 W Drake Rd - Applications/Reroof - 11/02/2017 (2)City 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 Gg oofing ❑ 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 # gon o Date h
Fnr office use on1v
lob Site Address (required) Value of Construction (labor, materials, profit)
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roperty Ow er Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phi I
Contractor Address city/State Zip Phone
Contractor City of Ft Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑Report
sales tax number is required bya//contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co�ercial prolect7 esidential ❑ Commercial '
If residential, is it Single Family Detached ❑ Condo/townho (single family attached) ❑Duplex
❑ Multifamily (apartment) 6d Garag� j
If commercial, is it ❑ Bank ❑ Bar El Church [IHotel/ otel ❑Medical office ❑Office ❑ Retail
❑ Restaurant ❑ Other (explai
ion
Is this building So years of age or more? ❑ Yes o If yes, you may need to contact Historic Prrservat
If this is for a demolition permit, what year was the building constructed>
Description of work !0 C
,
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*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 #
Electnoan
Plumber Mechanical Roofer 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: Date
Print Name Signature
Revision date V512017
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