HomeMy WebLinkAbout1700 Erin Ct - Applications/Reroof - 06/26/2018City 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 # t$�(MLN 0 Date
For office use only
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? 13:lere ❑ Report
sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes I�-,No
Is this a residential or commercial project? (Residential ❑ Commercial
If residential, is it: in lleFaFamil rDetached ❑ Condo/townhome (single family attached) ❑ Duplex
Mu tifT—amity (apartment ❑ Garage
If commercial, is it: 0 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 mayneed to contaetHistor/c Preservation
If this is for a demolition permit, what year was the building constructed? iL%a
Des ription of work V�,u( Q QS iaad i1 IQ5 f Y Ce h 2. (QUWrt"5. (
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license # rho( ICU Y, j I��
f
Electrician Plumber Mechanical RcoL 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: (o t t C R �V l (1N l/UV�,+ C26n� ' 6
Print Name: Signature Date �'l�� v
Revision date 216/2017