HomeMy WebLinkAbout919 W Mountain Ave - Applications/Reroof - 09/24/2018Wl ' 4'Planning., Development, & Transportation Services
:for Collins(�g.,
'ram-�_�,...►. Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80824 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 onlYjaheck all that apply), El Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not servic change) ❑ G L'
❑ Heating Unit ❑Lawn iprinkl
er ❑Mobile Home replacement as Ighter ❑ Gas Log
Sewer Line
❑ Ventilation ❑/ater Heater ❑Water Line C] Wood/Pellet Stove (must be E❑PA certified, pro❑vide makelt
manufacturer). model and
Complete aii applicable information on the application. Incomplete applications will not be accepted.
Application # &;?g J 1 .1C
For office use on/y -- Date 9 • ON.
Job Site Address (requires)
I Ave- / Value of construction (labor, A.
materials, profit)
Property Owner Name
Address
Applicant Name l— ASS
Contractor Address
ontractor City of Collins Sales Tax #
Sa/es tax number is required by all contractors
� UVJ4 %241aO 00
City/State Zip Phone
WtAL z5 55'
City/State Zip Phone
City/State Zip Phone
r• _
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commerci �l project? Resiclential C7 Commercial
If residential, is it: 0 Single Family Detached Ll Condo/townhome (single family attached) ❑ Duplex
artment) 0 Garage
If commercial, is it; 0Bank ifainilY p
11 Bar❑ Church CJ Hote%Motel ❑ Medical office ❑ Office ❑ Retail
-El ResIs this building So years of ageint or more❑? 0❑ ther Yes ❑IainNo) lfyes; you may need to contact Histor/cPreseruat/on
If this is for a demolltion permit, what year was the building constructed?
Descriptior, of work( ij 11A/11 _ e %-_• .
*If lawn sprinkler/t t;ckflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcmntractors: List thecompan}I name or City of FtCollins license#
Electrician7——
Applllcant: Plumber
Mechanical__Roofer
I hereb Other
y I have read this application and statethat the above information is complete and correct. I agree to
comply wts contained herein and city ordinances and state laws regulating building construction. I know that a
permit iit has been paid and issued.
Applicant:
Print Name; 1
Signatur
Date i
Revision date 2/6/2017 --