HomeMy WebLinkAbout3715 Cosmos Ln - Applications/Reroof - 06/26/2018OVER-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 # PJ�0b 0 5�� 1 Date OLDFor office use onty
Job Site Address (required) _ Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
- 3'4I ,S- co t.(A_i -�-Gait, 2 S 10s-31
Applicant Name Address City/State Zip Phone
Contractor Address Gty/State Zip Phone �U�Q
80
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number /s mqu/red by all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or min rcial project? sidential ❑ Commercial
If residential, is it gle 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? 0 Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work '' !2 c¢ 04 Sk i,
*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, mubt list licensed electrician
Subcontractors list the company name or City of Ft Collins hcense #
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 —�-- l
Pnnt Name �i � (` C"n ce� e__Signature Z Date
Revision date W12017
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