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HomeMy WebLinkAbout421 Lilac Ln - Applications/Reroof - 09/21/2018City of p g Planning, Development, & Transportation Services F6rt 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 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 ipforynation on the application. Incomplete applications will not be accepted. Application # _3 X) For o>irce use only Date gal%o/-Z lob Site Address (required) Value of Construction (labor, materials, profit) 7�a, r'16 LYl ©S'a 7b-,yyv- Property Owner Name Address City/State Zip Phone e Le I zSa agY_- �a 6 Applicant Name Address City/State Zip Phone l (/ Contractor Address City/State Zip Phone 2 race ,k /ge- ta70- 309- a Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? a-Flere ❑ Report Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or com�mercial project? 2 6sidential ❑ Commercial If residential, is it: 2'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 (explain) Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation If this is fora demolition permit, what year was the building constructed? Description of work o p �s �a *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 ?- / AP 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: Print Name: ,) � cu l Signature Date a 6?O Revision date 2/6/2017 JrK.. .