HomeMy WebLinkAbout3025 W Stuart St - Applications/Reroof - 03/07/2018 (12)city of Planning, Development, & Transportation Services
/�F�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.
Application # Tj 6 tiv , & -
For ofce use only
Incomplete applications will not be accepted
Date 2- / f g
Job Site Address (re ed) � Value of Construction (labor, profit)
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Pro OwngrName Address City/State Zip Phone
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(ARpllcant Name
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ontractor Address City/State Phone
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Con ctor City of Ft. Collins es Tax # Are you paying taxes here or by report? iIFI44ere ❑ 1 eport
Sales tar number isrequvedbyall contractors Are you paying with your trust account? ❑ Yes o
Is this a residential or commercial project? ❑ Reside teal ❑ 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 (ex ain)
Is this building 50 years of age or more? OYesFNo If yes, you may need to contact HlstoncPreservatlon
If this is for a demolition permit, what year was the building constructed?
De cription of work 5 lv s
*If lawn sprinkler/backflow preventer, must list licensed plumber If first -,time A/C, must ' t licensed electrician.
Subcontractors: List the company name orOtyofFtCoffins bcense# ,2Q3
Electrician Plumber Mechanical Roofer -, w2— / ' 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 regulabn building construction I know that a
is it ha4pald
permit not valid until issued.
Applicant: in ' /�Print
` �C 4Date 3-7
Name• 1 1 ignature
Rawson date 2/6/2017
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