HomeMy WebLinkAbout3001 Eagle Dr - Applications/Reroof - 12/07/2017F6City of Planning, Development, & Transportation Sery
r. t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main- 970,4162740 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 servicechange) ❑ Gas lighter ❑ Gas Log
❑ Heating Unit ElLawn Sprinkler ❑ Mobile Home replacement Nhloofing ❑ 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 #_ b \-io os-3 1
Date �'(��1 /�-7 j
For office use only
J#teAddrequired) Value of Construction (labor, material profit)
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PAddress Gty/State Zip Phonep
F, / U - 22 _ qlA
A ress Gty/ tate Zip Phone
�Z�1 Mu l � �tl-�e`� C611 o " z
Contractor Address City/State Zip Phone
1 � Z57-
Contractor City of Ft. Collins es Tax # Are you paying taxes here or by report? ❑ Here
❑Report
sales tax number is required by allconbactms. Are you paying with your trust account? ❑ Yes
❑ No
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Is this a residential or co5percial project? esidential ❑ Commercial
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If residential, is it- N Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
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❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑Other (explain)
Is this building 50 years of age or more? ❑ Yes 64 Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
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*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 Collins license #
Electrician Plumber Mechanical Roofe Other
I hereby acknowledge that I have read this application and state that the above information )rrect. 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: fy-K
Print Name. t
Signature Date I I/
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RemMn dare 2rsrmn V