HomeMy WebLinkAbout706 Blue Mesa Ave - Applications/Reroof - 07/09/2018city of Planning, Development, & Transportation Services
-City 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 in tion on the application Incomplete applications will not be accepted
Application # CJ Date l�
For oince use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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
Contractor City of Ft Col Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number Is required by all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? fid Residential ❑ Commercial
If residential, is it [9 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 ❑ No If yes, you may need to contact HistoncPreservation
If this is for a demolition permit, what year was the building constructed?
Description of work 6 &A &J-iE
*If lawn sprinkler/backflow preventer, must list licensed 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 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 �'� �yG Gi'v Signatur to l �l
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Revision date 2/6/2017