HomeMy WebLinkAbout2500 Charolais Dr - Applications/Reroof - 06/13/2018City of
Fort Collins
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Planning, Development & Transportation
281 N College Ave P O Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 %'Z�z j\
Application # �J D�Li I Date
For office use only `7
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
ere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ es ❑ No
Is this a residential or c mmercial project? -Residential ❑ Commercial
If residential, is it A 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 SO years of age or more? ❑ Yes k)No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application
Description of work P'7-- "-F a-, e-Zc21154L:
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*If lawn sprinkler/backho'w"�reLsnte , - icensed plumber If first-time A/C, must list licensed electrician
Subcontractors List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer then
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 Name �' L I jfb� l _ r t i.bsq Signature
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