HomeMy WebLinkAbout2324 Kechter Rd - Applications/Reroof - 03/26/2018R - 3&76,
FCity of Planning, Development, & Transportation Services
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. Incomplete applications will not be accepted.
Application # g5l l ooy ( 61-7 b Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Pro erty Owner Name Address Gty/State ` Zip Phone9`4.
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Applicant Name J Address City/State Zip Phone
Contractor 1 Address City/StateZip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Sales tax number is required by all contractoin Are you paying with your trust account? Yes ❑ No
Is this a residential or mmerclal project? Nesidential ❑ Commercial
If residential, is it: AQ 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistbricPreservadon
If this is for a demolition permit, what year was the building constructed?
Description of work C' Q lnC' L -�_
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*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
Subcontractors: List Me company name or City of Ft Collins license ig
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: I ✓ U rV Print Name: Signature
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