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HomeMy WebLinkAbout2918 Stover St - Applications/Reroof - 10/08/2018City oT Planning, Development, & Transportation Services Fort Collins Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134 L OVER-THE-COUNTER PERMITS ONLY a 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 4ighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ,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 # For office use only Date Job Site Address (required) Value of Construction (labor, materials, profit) 2-AI Q _C U e; - E--o 0 Prope Owner Name Address City/State Zip Phone DV S �_%\ 1 g sk Co &DS 5' a-)u zAz On Applicant Name Address City/State Zip Phone ft 0,�ko ",,,, o Contractor Address City/State Zip Phone N\00A S1;�.�.es �i� f, �� i q to a Contractor City of Ft. Collins Sales Tax # Xre you paying taxes here or by report? ❑ Here ❑ Report Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? 'Residential ❑ Commercial If residential, is it: 'Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (expla'n) Is this building SO years of age or more? ❑ Yes.KNNo If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work 'e, S©o% w� Z c *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license # Electrician Plumber Mechanical Roofer 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: `/—�' 1 10 Print Name: � -' � ���\ Signature X A Date QVJ 91 Revision date 2/6/2017