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HomeMy WebLinkAbout743 Grouse Cir - Applications/Reroof - 12/27/2018City 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 1 lam-.7/ 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 ange) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ 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 # 15a I �� For ofce use only Date / ;� • a 2• 1 D Job Site Address (required) Value of Construction (labor, materials, profit) 793 G� oar car Aso c� Property Owner Name Address City/State Zip Phone A 0� if o�t� rcw� � �i'3 r , �Cl � `��ll ✓T lap o28© 3S3 _ Applicant Name Address City/State Zip Phone �c1 v o CAD'u1s-_ 3(0 13 5, \_k� 0, pd, L( Co 00 --Q3 l 6413S Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 e'R Sales tax number is required byall contractors. Are you paying with your trust account? ❑ Yes f3-No— Is this a residential or commercial project? El Residential ❑ Commercial C3 S If residential, is it: ingle 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 9-No—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 ilOAJA , t—Stc rct *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 ofFt Collins license # Electrician Plumber Mechanical Roofer 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: ve.e` U k b lot. �� Date Print Name. Signature Revision dale 216/2017