HomeMy WebLinkAbout304 Toronto St - Applications/Reroof - 09/11/2018aCitvof Planning, Development, & Transportation Services
rt 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. Conditioning
❑ Deinolition (interior non-structural) ❑ Electrical t Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement IIYKoofing ❑ 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.
Application #_ Date _ CI I I I I Ig
For office use only
Job Site Address (required) i Value of Construction (labor, materials, profit)
Oq "( yl+I) S4 - -fay� i l VIS 8 0
Property Owner Name Address City/State Zip Phone
?)Dq Towhsl I aq - -1q IS -IN913
Applicant Name Address City/State Zip Phone
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Contractor Address
• Cit'/Sthth Zip 2� Phone
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Contractor City of Ft Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tar number is required bya0mntraciars Are you paying with your trust account? ❑ Yes ❑ No
FIs
is a residential orrerdal project? esidential ❑Commercial
sidential, is it: le Family Detached ❑,Condo/townhome (single family attached) ❑ Duplex
ifamily (apartment) ❑ Garagemmercial, is it: k ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai
is building 50years of age or more? ❑ Yes IWNo 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 r\ C
a
07
*If lawn sprinkler/badAlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins license #
Electrician Plumber Mechanical Roofer 0 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: n
Print Name: ll� Signature47g;�� Date g
ReN3ion date 2fjM17 V