HomeMy WebLinkAbout401 Franklin St - Applications/Reroof - 07/23/2018City of Planning, Development, & Transportation Services
Fort 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). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (notsery Moofin
❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Neater ❑ Waterline ❑ 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 # �1 �� �� h'� Date /S 3 i g
For ofte use only
Sob Site Address (requlred) Value of Construction (labor, materials, profit)
01 Fra/? Ll i Y) SF iC co 8 6Sa 00
Property Owner Name Address City/State Zip Phone
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Applicant Warne v Address City/State Zip Phone
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
SeYlwtwnumbe-srequired byall roMract=. Are you paying with your trust account? ❑Yes 9�40
Is this a residential or commercial project? ii esidential '❑ 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 5o years of age or more? ❑ Yes ❑ No Ifye$ you may need to contactHistaric Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work /<o 5pafe-sip (( .slam - -rear ofF and rerooc Jo COde,
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*If lawn sprinkleribackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
Electrician Plumber Mechanical Roofer e O O 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 ordinance and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
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Applicant: Z 3 lint/
Print Name: Signature Date
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