HomeMy WebLinkAbout545 Muskegon Ct - Applications/Reroof - 10/07/2018City of 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
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) ❑ 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).
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Complete all applicable'lnifq atition on the application.
Application # - V V 1� I
For office use only
Incomplete applications will not be accepted.
Date 116--- 3 4
Job Site Address (required) Value of Construction (labor, materials, profit)
5 S
Property Owner me Address Cit State Zip Phone
�Y I VamnS � VJ . � � 72- g115
Applicant Name Address City/State Zip Phone
W • - VL-v b
Contractor Address City/State 0 Zip e-2 Phone
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Contractor City of R. Collins Sdes Tax # Are you paying taxes qere or by report? ❑ Here ❑ Report
sales tax number ismquiredbyall contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? C&Residential ❑ Commercial
If residential, is it: N 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to mntactHistoricPreservadon
If this is for a demolition permit, what year was the building constructed?
Description of work Vi a&r czadi!ao 2dwrtA ki
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cityof Ft Collins license # %
Electrician Plumber Mechanical Roofer F uOther
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: I ! / /y
Print Name: l �l/I,m, ���z Signature Date
Revision dale 2/6/2017