HomeMy WebLinkAbout1707 Essex Dr - Applications/Reroof - 06/13/20186City of Planning, Development, & Transportation Services
rt 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 W*4"ofing ❑ 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 acre ted
Application #_ 2 � Ub y� /) 3 S
For ofte use only
p.
Date /l S he8
Sob Site Address (required) Value of Construction (labor, materials, profit)
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Prop rty Owner Name Address City/State Zip Phone
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Applicant Na Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. CoinsQles Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number ®iiredbyall mn radws Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co ercial project? esidential ❑ Commercial
If residential, is it: M'Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motet ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑Other (explai
Is this building 50
years of age or more? ❑ Yes to Ifyes, you may need to mntactHistancPreservadon
If this is for a demolition permit, what year was the building constructed?
Description of work
'1 e
*If lawn sprinkler/badfflow preventer, must list licensed plumber. If first-time A/Cr must list licensed electrician.
Subcontractors: Llst the company name or G'ty of Ft Collins license �i�(�
Electrician Plumber Mechanical Roofer.w -4 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 Name: h Signature Date
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