HomeMy WebLinkAbout2624 Canterbury Dr - Applications/Reroof - 11/29/2017City of Planning, Development, & Transportation Services
F,rt 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 # 2)110W9 9 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Pro pe Owner Name Address City/State Zip Phone
"Tole 1V h 1 "I0o Ca 4-C- {-c,1t o K 'F-4, LD ff (%r
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
F l� �01-1 �hc. D
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? MResidenbal ❑ Commercial
If residential, is it- Gft'Single 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 (explain)
Is this building So years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistoncPreservation
If this is for a demolition permit, what year was the building constructed?
Description of yvorK a AAA fM &4 J JQ_
*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 collets bcense #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above informabon is complete and 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:
Print Name* Signature Date
Ravison date ZU2017