HomeMy WebLinkAbout611 S Loomis Ave - Applications/Reroof - 09/17/2018cj4 0 s
FCityof Planning, Development, & Transportation Services
ort 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not se ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement WZofing ❑ 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 riot be accepted.
Application # U%0"bbAJ)_Date G t�l l
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip
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A pl�Name 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 A paying taxes here or by report? ❑ Here yeport
sales tax number iarequired by,all contractom Are you paying with your trust account? ❑ Yes No
Is this a residential or yommercial project? Rf Residential ❑ Commercial
If residential, is it: ® 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
❑ Restaurant ❑ Other (exp in)
Is this building 50 years of age or more? ❑ Yes [No Ifyes, you mayneed to, contact Historic Preservation
If this is for a,demolition permit, what year was the building constructed?
Description of work
E- o r -
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*If lawn sprinkler/backflow preventer, must list licensed plumbe . 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: g ``��1'�
Print Name: (C Signature Date
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Revision date 2WO17