HomeMy WebLinkAbout2701 Pampas Dr - Applications/Reroof - 12/15/201713G.SU
City of
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Planning, Development, & Transportation Services
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 servicechange) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Spnnkler ❑ Mobile Home replacement 5?11oofing ❑ Sewer Line ❑ Photo-v6ltaic
❑ 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) � 1
For office use only
Date _l2f�i
caw 01Ln wuuress (requ/rew Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins es Tax # Are you paying taxes here or by report? ❑ Here ' ❑ Report
Sales tax number IsrequIredbya//contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or coinwercial project? esidentiai ❑ Commercial
If residential, is it [mingle 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 (explai
Is this building 50 years of age or more? ❑ Yes MIN If yes, you may need to contact Htstonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 1'
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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 City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete an 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: Iy
Print Name: l' t Signature ' Date I 15
ReMV0. aato M2017