HomeMy WebLinkAbout605 Princeton Rd - Applications/Reroof - 08/28/2018FortCity O1 Planning, Development, & Transportation Services
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 KRoofing ❑ 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 # n 1 q) C) e?) a LN
For ofce use only
Job Site Address (required)
(405 Pr►f Am Kd F�r� Ccllin5 , 805ZS
Property Owner Name Address
9tcl� t Ann Foot (415
Applicant Name Address
k� ,+FxAt ior5 634, E Ck 1 c,
Contractor Address
'LTG ,,,G .� E t-tors Lk
Date o/ 28�j Q)
Value of Construction (labor, materials,
profit)
City/State
Fuv wkir5 CO.
Zip
8052S
Phone
` io-yBy-
TCity/State
J61nny burl CO.
Zip
B655-{
Phone
Li-lf\' ( _-'
City/State
Zip
Phone
It
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f,
Contractor City of Ft. Collins sales Tax # Are you paying taxes here or by report? �I Here ❑Report
Sales tax number Is required by all contractors. Are you paying with your trust account? ❑ Yes 0 No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: Z Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily
If commercial, is it: ❑ Bank ❑ Bar p ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 11 No 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 --
*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 ip La3
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:t aaf G G`5UM ' 8
Signature �Date
Revision data M(2017