HomeMy WebLinkAbout2120 Clipper Way - Applications/Reroof - 10/01/2018FCiiyof Plart�/rag°, Development, & TransportWion services
ort 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 Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement bi'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 # �b'l ?)b lbS cl3 Date _ 1111 S
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
0 chwkV W hVI O `VI SEA $ 5 DOD
Property Owner ga6 Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Oes Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequired byall conbactors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or comm�ercial project? esidential ❑Commercial
If residential, is it: WSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑
A
Multifamily (apartment) El Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail Stoyv
❑ Restaurant ❑ Other(explai
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact HistoricPreseruaPon
If this is for a demolition permit, what year was the building constructed?
Description of work Yiv'A5 ^' GE
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*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 I "*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: `
Print Name: T Signature Date
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