Loading...
HomeMy WebLinkAbout631 Gallup Rd - Applications/Reroof - 02/22/2018'WX Xos Fort Collins 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 D-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. �" r )� Application # i P II�-7 Date CP�c�l�� (lJ For office use only Job Site Address (required) Value Value of Construction (labor, materials, profit) J17 Pro/perry Owner Name Address City/State Zip Phone Applicant Name Address City/State l%jVl/ Zip Phone r f i CY Z 3 Contractor Address City/State Zip Phone /V 3 c l Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? El"Here ❑ Report sales tax number is required by all contractors. Are you paying with your trust account? U-Yes ❑ No y r 3 6A Is this a residential or commercial project? ❑ Residential ❑ Commercial If residential, is it: ED/Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail 1 ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes 63 No if yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work 0% *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 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. Applicant: , / ii - \1 J Print Name: ✓ �/l / L C J Signature .Ji r� .'Pi- . Revision date 21612017 Jam.