HomeMy WebLinkAbout916 W Mountain Ave - Applications/Reroof - 09/04/2018City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO M24 Main: 970AI62740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permlts only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit C Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Water Heater ❑ Water Line ❑ Wcod/Pellet Stove (must be EPA certified, provide make, model and
iJ Venu atlon
manufacturer).
Complete all applic e i fo ation on the�lication.
Application #
r I nhi
Incomplete applications will not be accepted.
Date 8t0Z 4 0 d3S
]ob Site Address (required) Value of Construction (labor, materials, profit)
q\6 'W, a�c� Ave,
Property Owner Name Address City/state Zip Phone
Ild �b c�ootC q16, +� mounloun PN� oc�(` o�Src►S �Cb 605a1 4-1b)2i+- J03
Applicant Name Address City/State Zip Phone
ill A izob oK S 16 cx�n�o�n l�vI-V;6- QCO\bns RI 4,10�2A-R:
Contractor Address City/State Zip Phone
Contractor City of R. Collins les Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
��rnumaerisrerrwredbyancon d�rs, Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or omo�}nmerdal project? Residential ❑ Commercial
If residential, is it LSSingle 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? r3 Yes 17 No If yes, you mayneed to contact Ksrnric Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work _ k>'(k o?i Sa cilp-\-aV•
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
subcontractors: List the company nanear City of Ft Collins llcensz? #
ElecYr4dan Plumber Mechanical Roofer der
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 beret❑ al u city ordinenc= and ewta lowc roguloting building rnndruction. I know that a
permit is not valid until it has been paid and issued. MM l p
Appricanib signatur Date �_� Vr `U
Print Name:��r
Revision dWa ZVMI7
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