HomeMy WebLinkAbout3050 W Stuart St - Applications/Reroof - 03/07/2018City 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
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 # 14-1 L\ Date _ ,� —/9
For office use only
UbSite Addr (required) Value of Construction (labor, materials, profit)
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Pro erty Own�Na�e Address 10 City/State Zip Phone VO
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Applicant Nam Address City/State Zip Phone ef'770
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Contractor Address City/State Zip Phone '%/a
M0� fiZ 223-cYr3
Co actor City of Ft. Collins Sales'Tax # Are you paying taxes here or by report?ere ❑ Report
Sales tax number is required by allmn"ctors Are you paying with your trust account? ❑ Yes elo
Is this a residential or commercial project? ❑ Residenbal ❑ Commercial
If residential, is it: ❑ Single Family Detached Gmclo/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 If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year wa a building constructed?
-D Jrcaf w ption ok i lu� (tee 5
*If lawn sprinkler/backflow preventer, must list licensed plumber If fi t- mg C, must list ensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license #7
Electrician Plumber Mechanical Roofer-9 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 regulabng building construction I know that a
permit is not valid until it has been paid and issued. (�
Applicant:
Print NamSignature
Ram= date 2/6/2017