HomeMy WebLinkAbout2230 Shropshire Ave - Applications/Reroof - 12/12/2017City of Planning, Development, & Transportation Sery
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 Cor? itioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not services change) [I Gas Lighter ❑ Gas g
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ®'Roofing ❑ Sewer Line ❑ Photo-volttic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, odel and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepts
Application # 2) 1`10IbSas Date !2
inr Airro „W MrV
value of Construction pabor, materials, profit)
Job Site Address (required)
31
22_50
Property Owner Name Address �/Stabe Zip Phone
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59R0
Applicant Na Address City/State Zip PhIII
one
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Contractor Address Gty/State ZIP 2KZ P�Fione
-7
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Contractor City of FL Collins es Tax # Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? ❑ Yes
O Report
No
sales tax number ismqu&Wbya#mn7aeibm
i
Is this a residential or compercial project? idential ❑ Commercial
is it: NMngle Family Detached ❑ Condo/townhome (single fame attached) ❑Duplex
Z
If residential,
❑ Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel O Medical office O office ❑ Retail
!
❑ Restaurant 0 Other (explai
Is this building 50 years of age or more? ❑ Yes o Ifye_5 you may need to cvnhwt Histodc Premservat0:r
If this is for a demolition permit, what year was the building constructed?
Description of work
I I
III
*If lawn sprinkler/backfiow preveriter, must list licensed plumber. If first-time A/C, mast list licensed el
on.
Subcontractors: List the company name or City of ft Collins llcense #
Otlher
Bectridan Plumber Mechanical Ro4knd
I hereby andmowledge that I have read this application and state that the above information is complnett. Ib
laws regulating building construction• I know
agree to
that a
comply with all requirements contained herein and city ordinances and state
permit is not valid until it has been paid and Issued.
Applicant: /i SignatureDate
Name: W
III
I
nerlalon date Berzon