HomeMy WebLinkAbout1719 Glenwood Dr - Applications/Reroof - 11/17/2017City 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 # ;2> n D -C) Date 11 1
For oRrce use only
lob Site Address (required) Value of Construction (labor, materials, profit)
1 R kkyw d Dr . I L1�0
1�C�Ioo
Property Owner Name Address City/State Zip Phone
WM'%0,M PgN\l \ 1 � Or. k Q0%M 1 0 O%Zp 010 11 IScl8
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
h Ya ' 0Y1 UM0 w 10 Y • CD 60(gq 970 cx)-
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number Isrequlredbyall contractors Are you paying with your trust account? ❑ Yes j(No
Is this a residential or commercial project? J'Residenbal ❑ Commercial
If residential, is it, ta 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)4No Ifyma you may need to contactHistorrc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work RE do ak r Y g
+_'Vt t
25 EO
*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 #
Electrician Plumber Mechanical Roofert 1V ` oA o 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:
Print Name, 101 J tL Signature , Date
Revision date 2/6@017