HomeMy WebLinkAbout128 N Mckinley Ave - Applications/Reroof - 10/12/2018City 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 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 # eF — S I + _ Date ' t ' r 8
For office use only
Sob Site Address (requlred) A Value of Construction (labor, materials, profit)
129 1nc K1N1.Ey 4VE Fo0-r C7ULL/+✓S eo y05'z 1 21 ,�- Z 5TWZ y
Property Owner Name Address City/State Zip Phone
ejM1315P,Ly MCh iAJA /zg 1&*d. Lty 4-"F Fo.er (00.1 e /-, 4 z v 8'u3,2 l 970-3og- llg//
Applicant Name Address City/State Zip Phone
M J�Ay�NS oi AC41)�__My er- d Zoo Fo,.Y Coe.e/ v; e o F,0SZ4 97D=d,gl-l'L3b
:Contractor Address ::City/State Zip Phone
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Contractor City of.Ft. Coliins'Sales Tax-# ..Are you,paying_taxes here or by report? :❑:Here -.Report
saiesraxnumberis.requiredaya2contrdctors .Are you- paying with .your trust account? -❑ Yes : ❑.No
:_Is:this a residential or. commercial project? .ArResidential ':❑:Commerdal
.:If:residential,Is.it: .firSingleFamily Detached '❑.Condo/townhomd.(single-family attached) 1J•Duplex
❑ Multifamily.(apartment) .:❑:Garage
:If.commercial, is:it: ❑.Bank :13 Bar -❑"Church:•❑.Hotel/.Motel.'❑`Medical office 13 Office.:❑ Retail
=❑.Restaurant .'T3 Other (explaln).
:Is this building 50 years of;age or more? _-l7 Yes:❑ No ...Yyes, you may need to contact Historic Preservation
If. this is for a demolition permit; what year -was the. building -constructed?.
...Description of work &e or -I= C'oM/pGEr 24)tiF 7D A Felel vc AV rer ra.t ZAA vol3. lrvsr L..
SyvFhEr/c �Ecr1 �lP E�1� ICrA�+� i�rarFrL ,$;//Fcc1 Anrb A +10vR OL(It�N$ CJ2N/N�j
'If.lawn sprinkler/backflow preventer, must list licensed plumber; If first-time A/Ci-must list licensed:electrician.
Subcontractors:.Listthe.company name or City offtCollins license,#
Electrician Plumber :•'Mechanical Roofer. 1L'VEZ '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 statelaws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
..Applicant:
PPntName:Signature �" tG]o9a, Date
Revision date 2/8/2017