HomeMy WebLinkAbout2525 W Plum St - Applications/Reroof - 03/09/20180,10
�Ci2yof Planning, Development, & Transportation Services
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F"�lrt COtlins 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 # T)I)jl(Y 11 Date �� 1 Q' 1 e
For off use ony
]ob Site Address &Wu/red) Value of construction (labor, materials, profit)
5--
Property Owner Name Add City/State Zip j Phone
Applicant Name Address City/State 7lp / Shone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here P port
Sa�tax number isfequ&edaysnc n&acios Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, Is it: I�Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O 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 fo mntaatHh;WtJc Fhsservab(on
If this Is for a demoiition permit, what year was the building constructed?
Description of work L cag
*If lawn sprinkler/backnow preventer, must list ticensed pl ber. If first-time A/c, must list licensed electrician.
Subcontractors: Ust Me company name or OYy of Ft co///ns /!tense ,F
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:
Print Na Ig .,rc
Rev�I m 26r2o17
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