HomeMy WebLinkAbout2621 W Drake Rd - Applications/Reroof - 11/02/2017 (4)Cltv 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 '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 # z n D11M Date
rnr nfrirp iisp nnlv �11 \_ -2,0Z
Job Site Address (required) Value of Con uction (labor, materials, profit)
tigto
Property Owner gNme Address City/State Zip Phone
i
Applicant Nam Address City/State Zip Phone
Q- 157-C1 C At co� ai4er;S -+Cell o z
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins fies Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
❑ No
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes
Is this a residential or comyiercial protect? esidential ❑ Commercial
ingle Family Detached ❑ C��ndoJtownhome (single family attached) Cl Duplex
If residential, is it
❑ Multifamily (apartment) GrGarage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑Medical office ❑Office ❑ Retail
❑ Restaurant ❑ Other (explai 1
Is this building So years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
17
Description of work
A/A
*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must list lVicensed electrician.
Subcontractors: Lust the company name or City of Ft Collins Ocense #
Electrician Plumber Mechanical Roofer other
I hereby acknowledge that I have read this application and state that the above information is complete and rrect 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: ��ji/�,��Q� (� (Q Date
Print Name Y 1� +� 1' `- TD " . `"� Signature
Rmlion date 21WO17