HomeMy WebLinkAbout2150 Lager St - Applications/Reroof - 09/20/2018City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
6rt Colti s 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) 0 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O 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.
Application # &C7 Co 13
For office use only
3ob Site Address (required)
Incomplete applications will not be accepted.
Date _V-2d /l8
Value of Construction (labor, materials, profit)
$ 7-7-�[6.60
P,jrp'perty Owner Name Address City/State Zip Phone
/7 (11r1 A1�N MUN4h4 �031 �.5 '
se+k rsa LR9 e - Sf. Ff Cm //1a1S Co oSaSr 970 -3/0 -6 74s
Applicant Name Address City/State Zip Phone
Contractor Lic # Address City/State Zip Phone
�Xc%//fc up i��-13Si f5/�yE�srul,��ve' B&zc� Gouel l,Ca 8oS37 97v-S93-3a80
Contractor City of Ft Collins Sales Tax #
Sales wrn/A is requ1red bya/rconftacWxs
Are you paying taxes here or by report? Here 0 Report
Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? 0 Residential 13 Commercial
If residential, is it: q Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamly (apartment) 0 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 Hls4orlc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you wli/ need an asbestos as3e5sment to submit wftb this application.
Description of work
p�l s(p, SQ• � _ __
*If lawn sprinlder/baddiow preventer, must list licensed plumber. If fast -tune A/C, must list licensed electrician.
Subcontractors. List the company name or City off? Collins license #
Eiectridan Plumber Mechanical - Roofer .6v-Sjk Ir N� 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.