HomeMy WebLinkAbout2300 Panama Ct - Applications/Reroof - 12/11/2017City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Flirt Coltins Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 Strive (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted. 1a
Application # Date
For office use only
Sob Site Address (required)
Value of Co struction (labor, materials, profit)
Z �aram4 �
7
Pro rty Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Ablpivha / f
z
1f Z Ro/
Contractor Address
City/State Zip
Phone
Q
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here
❑ Report
Sales tax number tsrequiredbyall conbac ors
Are you paying with your trust account7 ❑ Yes
;9 No
Is this a residential orcog�mercial project? J9 Residential ❑ Commercial
If residential, is it: JB�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 50 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Of
90
*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 Acense #
Electriclan Plumber Mechanical Roofer �Z Other
I hereby acknowledge that I have read this application and state that the above information 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: - K,
Print Name:(DO "` V " ' Signature � Date