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HomeMy WebLinkAbout2120 Lager St - Applications/Reroof - 09/25/2018� d 9/2 s1l8 Cit of F®ryt Collins 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). 0 Air conditioning ❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log O Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing ❑ Sewer Line . 0 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 # 3I 8 C%W(Ob5 Date /-2a/id For office use only Job Site Address (re9uired) I Value of Construction (labor, materials, profit) alao L49er S74 II $ 75zo ?. oo Property Owner Name Address City/State Zip a y - Phone karbo.. fiwclexsem .zlao Lag err /=f,Ca///14 Co 805� 97o-31a-3oy� Applicant Name Address Contractor Uc # Address lyayG- Contractor City of Ft Collins Sales Tax # Sales raxn/A is feWred by all ca aacmys City/State Zip Phone City/State Zap Phone L�pfau� CD �a�3?' 970 �93-30�0 Are you paying taxes here or by report? 0 Here 0 Report Are you paying with your trust account? It Yes ❑ No Is this a residential or commercial project? EX Residential ❑ Commercial If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank Cl 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 Hlstodc Preservation If this is flor a demolition permit, what year was the building constructed? Ifpr/or to 1975, you wIN need an asbestos assessment to subm/t m i thJs appl/cabon. Description of work n[ I fiC� • � `� *If lawn sprinkler/baddiow pteventer, must list licensed plumber. If first-time A/c must list licensed electrician. Subcarrtiactors: list die company name or ofRCollins license # Electridan Plumber Mediartiml Roofer 1:'Or /oQ P S Other a o!'li 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. Print Name: i /star ©o S nature Date �410 �/