HomeMy WebLinkAbout1505 S Bryan Ave - Applications/Reroof - 10/04/2018Fcity of Planning, Development, & Transportation 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 ❑ 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 #N9)(_)%D 1 7 Date 10/MI S
For offlce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
5o S. Jp- a?700. Co
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
1 owor) 5 7 -
Contractor City of Ft. Collins Sa s Tax # Are you paying taxes here or by report? mHere ❑ Report
sales tax number Isreauiredbyall contractors. Are you paying with your trust account? IZYes ❑ No
�-I lo.y
Is this a residential or commercial project? (Residential ❑ Commercial
If residential, is it: XSingle 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 ;KNo 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 a $` \
Lu. :11
*If lawn sprinkler/backflow preventer, must t licensed p umber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or City of Ft Collins license # Q
Electrician Plumber Mechanical Roofer 1� 1y�� 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:_ Signature Date i®/q
Revision date 2/6/2017