HomeMy WebLinkAbout1613 Richards Pl - Applications/Reroof - 12/18/2017Cityaf 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
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OVER-THE-COUNTER PERMITS ONLY
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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) I
Complete all applicable information on the application. Incomplete applications will not be accepted
Application # b 1-+686 m Date I2• IR 12
For ofte use only l
lob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
Applicant Na a Address City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all conbaclas Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or coT_mercial project? ❑ Residential ❑ Commercial
If residential, is it: SCE ingle 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 If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work- TSO V.&- zx-46rauC., 0 v.w, O_V �—��o.\rC.%
*If lawn spnnkler/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 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.
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Applicant: Print Name: DOi- /
�CLC S Signature Date a 19 `
Re Iwon date 2/6/2017