HomeMy WebLinkAbout2406 Montmorency St - Applications/Reroof - 11/20/2017FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
s- 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 se Ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement kA 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 #
For office use only
Date I Ldll•a��Tn�7��
Job Site Address (required) Value of Construction (labor, materials, profit) 92S
P perty Owner Name Address City/State Zip Phone
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Ap icant Name Address
Address City/State Zip �y Phone u( `?a
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aontractor r,�_ Address City/State Zip Phone 926)
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Contractor City of Ft. Collins Sales Tax # -�S� `JjJ Are you paying taxes here or by report? XHere ❑ Report
Sales tax number is requved by all contractors Are you paying with your trust account? ❑ Yes t`IfNo
Is this a residenbal or commercial project? Residential ❑ Commercial
If residential, is it, El Family Detac ed ❑ 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 Ht tonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work �' 1 T ^ 2 c)f'1
r ZY
*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer _RW✓ ;IAJG 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. IZ15- M Signature Date U
aemmon date 252017