HomeMy WebLinkAbout3107 Silverthorne Dr - Applications/Reroof - 05/31/20181121-ilt
City o�ollins
Planning, Development, & Transportation Services
,Fort 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 P,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 ipgormation QQ the application Incomplete applications will not be accepted
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Application # Date ' �3
For o rce use only
lob 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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fApplicantkName Address City/State Zip Phone
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Co tractor ✓ Address City/State i Zip S01/0 Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report?'a Here ❑ Report
Sales tax number is required ball contractors Are you paying with your trust account? ❑ Yes No
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Is this a residential or commercial project? M, 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 50 years of age or more? ❑ Yes )1 No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed? �J0
Description of work \tC,,v hO(AP CO&C r C t laQ t niJt* LA, 4 VN _Fawk to 0( v )U4 C ?J-0 �
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*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must leis licensed electrician
Subcontractors List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer K - f 75 , Other
I hereby acknowledge that I have read this application and state that the above i formation is complete and correct I agree to
comply with all requirements contained herein and city ordinances and7st;ate`law regulating building construction I know that a
permit is not valid until it has been paid and issued I
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Applicant
Print Name �A-1) ��' 7t�-% Signature 1� Date
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