HomeMy WebLinkAbout2515 Manet Ct - Applications/Reroof - 11/13/2017City 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 /17
will not be accepted.
Application # 044(�4 Date 1 % Zj
For office use only
Job Site Address (required) Value of Construction (labor, materials, profithod"
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Proplerty Owner Name/ Address City tate _ Zip Phone
Ap icant Name Address City/State Zip Phone C00
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Contractor Address City/State Zip �1 Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? GdHere ❑ Report
Sales tax number is requ4-°by all contractors. Are you paying with your trust account? ❑ Yes 70No
r- ac�r�
Is this a residential or c mmerdal project? Residential ❑ Commercial
If residential, is it: ta.5ingle 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work idG' ` 20, S
*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 # !fit S t
Electridan Plumber Mechanical Roofer 0061f A-C- 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: ,,,��,,.t�
Print Name. /`7^'LI�Signature Date %Izy� 7n
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Revision date 2WO17
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