HomeMy WebLinkAbout2102 Saison St - Applications/Reroof - 09/21/2018Cityof
F&t Colima
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 V 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 #�j aa� Date / (I%
For office use only
Job Site Address (required) `6�5i53 uy Value of Construction (labor, materials, profit)
fir CD `6O�CL ('3o3�N�Gy-W�1
Property Owner Name Address City/State Zip Phone
r*-\4'1 %Clt2L1 Clow ��110-�953
Applicant Name Address City/State Zip Phone
�cn�cs�\\t5a� �'�.00�-ox�ci \oy' U1U S • Li c�,ri _ Dex�vexC� �12.3 3cs3,y�ay- °ii�y
Contractor Address City/State Zip Phone
So cLp K30 s. LI bwve& CO 9C0 AM - s
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?' Kiiere ❑ Report
sa/estaxnumber&Muimdbyall mnt2rMrs Are you paying with your trust account? ❑ Yes No
soc a,4;
Is this a residential or c9prnercial project? EJ Residential ❑ Commercial
If residential, is It: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamlly (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaln
Is this building 50 years of age or more? ❑ Yes ErNo Ifyes, you mayneed to contact Histodc Preservation
If this is for a demolition permit, what year was the building constructed?
rfpr/or to 1975, you MY need an asbestos assessment to submit with this application.
of
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician, rl
Subcontractors: ListthemmpanynameorCity ofFtCollinsllcenseif p d
Electrician Plumber Mechanical Roofer 11 aa� 3 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_VTlf.