HomeMy WebLinkAbout804 E Elizabeth St - Applications/Reroof - 12/20/2017Planning, Development, & Transportation Services
Fort C011InS 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.
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Application # Date
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For use only
lob Site Address (rwu/nad) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
pliant Name Address V CityState Zi Phone
Contractor � � Address � Ci /� t): � � ZPhone
i %1(lj I
Contractor City of + Collins Sales Tax # Are you paying taxes here or by report? Here O Report
sates wxnwoffisrequired bya#conDacium Are you paying with your trust accounts PLYABS ❑ No
Is this a residential or�cqr1merclal project? OResidentlal ❑ Commercial
If residential, is It: 0-51ngle 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 No If yes, you may need to contact HisYoAc Pneervation
If this is for a demolition perm@, what year was the building constructed?
Description of work 1 r a
*If lawn spnnlder/bacidlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of R Collins %ease ,#
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and slate 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 consbucbon. I know that a
permit is not valid until it has been paid and issued.
Applikant; ` pin, 2 , Date L
Printma �' ; � "n Signature ✓ ��
Rm slon date 2/W2D17 j