HomeMy WebLinkAbout317 Park St - Applications/Reroof - 09/07/2018Cityof Planning, ®eveloprnent., & Transportation Services
a rt Collis 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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ 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 t* application. Incomplete ap lic £
Application #
30b Site
-1IeL
Foi ooffice use only
ss (required)
Property Owner Name
Applicant Name
Contractor
Contractor City of Ft. Collins Sams Tax #
Sales tax number is reou/red by all contractor;.
1� p a ions will not be accepted.
Date _Ci�'I/M
Value of Construction (labor, materials, profit)
1* lod • 00
Address City/State Zip Phone
Address City/State Zip Phone
n'Me r�iP�gyY{ g�,37 G?-1a"L7(a777
Address City/State Zip Phone
Are you paying taxes here or by report? WHere ❑ Report
Are you paying with your trust account? lZyes ❑ No
Is this a residential or commercial project? .Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
artment) 11 Garage
If commercial, is it: [I Bank a mlly p
❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
13 Is this building 50 yea Restaurant
a❑
age or more? ❑ Yes KNoOther ) Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was to building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plu er. If first-time A/C,
Subcontractors: List tare company name or City of Ft Collins license #
list licensed
Electrician Plumber Mechanical Q -1
Roofer `� Omer.
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:
Printmamel Signature — Date -3M 1
Revision date 2/6/2017