HomeMy WebLinkAbout2313 Coventry Ct - Applications/Reroof - 02/22/2018OVER-THE-COUNTER PERMITS ONLY 15q%
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 Ion the application. Incomplete applications will not be accepted.
Application # �,�; jq_ Date
For office use only
Job Site Address (tequlfed) Value of Construction (labor, materials, profit)
. vex,} ( �/. t _ C� S
Property owner Name Address City/State Zip Phone - [oc /
r
Applicant Name Address City/Sta Zip Phone
0 0 (U►^i�
Contractor Address City/State Zip Phone
Q�
_ 21 4, S --\ P L et of
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by reporti�mFlere ❑ Report
sales tax number isrequlredbyall mn&aa0m Are you paying with your trust account? ❑ Yes (� No
is this a residential or ca eroal project? ❑ R dential ❑ Commercial
If residential, is it: Single Family Detach 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?
Description of %ov /L C<-
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or Oty of H Collins license 0
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.
1141
Applicant:
Print Name: ��� G�f'e Signature z
Remew (We 2AW?