HomeMy WebLinkAbout814 S College Ave - Applications/Reroof - 11/15/2018City of Planning, Development, & Transportation Services
F6rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
U G1 4 9
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 # 191 b 1 U(� 3 b Date
For ofFce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
- -_�O-700, ro
Property Owner Name Address City/State Zip Phone
hJ l :l- l e LC A2 drA(,,K o o I-
Applicant Name�/ Address City/State Zip Phone
-A<6 I�CJIt SSo?/ c 6 ✓2 eI 05 0-3 - 361�
Contractor Address City/State Zip Phone
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1 e cou o2( Crcl e �7 D p_ -Toy -2
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
sales tax number is required by allcontwitors 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Des ript' n of ork ✓ "
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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 AW 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, G
Print Name: J e A U r Signature Date I /- l�c�D/
Revision date 2/6/2017