HomeMy WebLinkAbout2103 Lager St - Applications/Reroof - 09/20/2018City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
®rt Collins 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). O Air conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line . O 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 #_ f j -s C) R(a n), Z�- - Date
For ofli'ce use only
lob Site Address (required) I Value of Construction (labor, materials, profit)
�/03 Gnf� Sf $ 9793 6,6
Properly Owner Name Address City/State Zip Phone
P,61' cC_za+loci Morse_ ;?103 LayerS-f. 9&6� 7a1-'7.�/a--S3"(3
Applicant Name Address City/State Zip Phone
0 Illnw /!. /."/Vf4. rr-V
Contractor Lic # Address City/State ZIP Phone
c2-135`7 /y��/E EsPuQ�wu �li�l �nel�loud, �a s'DS3i �t7o-S?+?_keso
Contractor City of Ft Collins Sales Tax #
Sales trxR/fi as required byali conbads a
Are you paying taxes here or by report? I'M Here 0 Report
Are you paying with your trust account? JV Yes ❑ No
Is this a residential or commercial project? W Residential ❑ commercial
If residential, is it: 12 Single Family Detached ❑ Condo/townhome (single family attached) O 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? O Yes ®No Ifyes, you may need to contact Hlstudc Preservab'on
If this is for a demolition permit, what year was the building constructed?
Ifphlor to 1975, you Wit need an asbestos anent to submit widr this application.
Description of work
*If lawn sprinkler/baddlow pteventer, must list licensed plumber. If first-time A/C, must list licensed ele_ctricia_n.
Subcontractors: List tf►e company name or aty of Ft Comns l/cense �
Elemiaan Plumber Mechanical - Roofer _ i( Other
es
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.