HomeMy WebLinkAbout2114 Lager St - Applications/Reroof - 09/20/2018City of Planning, Development & Transportation
p� 281 N. College Ave P.O. Box 580
! 6rt 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line . O Photo -voltaic
❑ Ventilation O 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 # r I � =0�
For ofte use only
Job Site Address (rewuinad)
Date 9/70//5
Value of Construction (labor, materials, profit)
$ /a, yS 9, d o
Property Owner Name Address City/State Zip Phone
S Qt1�Tiwtgtiez Sal�w45
R6b.2 r+a sw l� gal; .Q5 .«c�a� / / �/ L�csae� S>< F 611bus Co 9DS,7 y 7®a -yips'- `l73o
Applicant Name
Address
City/State Zip Phone
Contractor Lic # Address City/State Zip Phone
zez'em &9t 2-135i SD537 �7o-S�3-3c�o
Contractor City of Ft Collins Sales Tax #
Sales raxn/Aeris requwbyalrconaacms: r
Are you paying taxes here or by report? 0 Here O Report
Are you paying with your trust account? PI Yes ❑ No
Is this a residential or commercial project? W Residential ❑ Commercial
If residential, is it: IV Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamly (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? ❑ Yes ®No Ifyes, you may need to contact Histaric Presenabon
If this is for a demolition permit, what year was the building constructed?
Ifprfor to 1975, you wff need an asbestos assessment to subm/t widr this appriiabon.
Description of work Qe,+reuP
*If lawn sprinider/baddlow pteventer, must list licensed plumber. If fast -time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Collins license #
Elechidar Plumber Mechanical Roofer LMdC4Other
I hereby admoMedge 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.
PrimApplicant //' I dl e! 5` ���"���'"" `�
Print Name: i lRaH 1yo S i r inature Date