HomeMy WebLinkAbout1108 Maple St - Applications/Reroof - 06/21/2018Planning, Development & Transportation
281 N College Ave P 0 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 b(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 #-i�� Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
574—
//047
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Property Owner Name Address
City/State Zip Phone
i� c 0/S
'�s'C r 7 70 z03-
Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
1f10s1_0✓ GMYY-k4 , t,r,
Dp 0D,41 454 L/a�DSa3-
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report7XHere ❑ Report
Sales tax number Is required by all contactors
Are you paying with your trust account? ❑ Yes XNo
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it ❑ 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 Historic Preservation
If this is for a demolition permit what year was the building constructed?
If prior to 1975 you will need an asbestos assessment to submit with this application
Description of work e- i21, r7 f- il C10141f r'114 111
n7� a7� -- •^ tt
*If lawn sprinkler/backflow preventer must list licensed plumber If fir time A/C must list licensed electrician
Subcontractors List the company name or Oty of Ft Collins 11cense #
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 unbi it has been paid and issued
Applicant �-�-- V
Print Name /i r» Signature Date c C