HomeMy WebLinkAbout2225 Dover Dr - Applications/Reroof - 09/27/2018a?5 i <�'
,,,�City of Planning, Development, & Transportation Services
,Ort CollinsCommunity 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 Conditionin
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not servi�Cchange) ❑Gas Lghter ❑Gas Log g
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement EI 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.
Application # 91 C60 5,L401 Date
For ofAce use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
-7-711 C n
Property Owner Name Address City/State Zip
C. - , -r' - t - - p Phone
Applicant Name Address
City/State Zip Phone
�)&„ pa"i I
Contractor Address AOS 2 s)
`--t t' _ City/State Zip Phone
contractor City of Ft. Collins Sales Tax # - V
Are you paying taxes here or by report? ❑Here El Report
Sales tax numberlsrequired byall contractom Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or _commercial project? Residential ❑ Commercial
If residential, is it: 19 Ingle 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 (expl
Is this building 50 years of age or more? ❑Yes No If yes, you may need to contactHistoricPreseruation
If this is for a demolition permit, what year was the building constructed?
Description of work
*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 sta laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Signature
Date
Revision dale 2/6/2017