HomeMy WebLinkAbout2619 Dunbar Ave - Applications/Reroof - 08/09/2018City of Planning, Development, & Transportation Services
®rt 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 information on the application. Incomplete applications will not be accepted.
Application # E (66(as�3 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
c)
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
I .� � , ��,r,,i� - t! ink +�. � �� d-3Y�►�
Contractor Address City/State Zip Phone
Coll(��e
Contractor City of 9t. Collin Sales Tax # Are you paying taxes here or by report? Cy Here ❑ Report
Sales tax number isrequired byall conbadom Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Q Residential ❑ Commercial
If residential, is it: Lff'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?
Description of work L - l 0 5 ,
1- up t. VC-4 V> t d
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license #
Electrician Plumber Mechanical Roof + t c 2. 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: i1 G
Print Name: 1 . ► C a Signature Date
Revision date 2162017