HomeMy WebLinkAbout393 Stout St - Applications/Reroof - 08/14/2018Aug 02 18 07:29p Severe Weather Roofing 9702233383 p.5
City.of Planning, Development, & Transportation Services
Fort Colhns 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 1
355
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Bectrical Alteration (not service change) C 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
Application A180)679`8
For office use only
Incomplete applications will not be accepted.
Date
]ob 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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Applicant Name Address City/State Zip Phone
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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? Mere ❑ Report
Sales tax number rsrequIredl; all contractors Are you paying with your trust account? ❑ Yes RNO
Is this a residential or commercial project? OResidential ❑ 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 50 years of age or mare? 0 Yes ;R;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 &MUCe _ -U of OWALlE 6WQVV,5
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*If lawn sprinkler/bacidlow 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 # �"9D�` u i�.,�_
Roofer' P1'm Other
Bectridan Plumber Mechanical
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: .t:C�T��`r vim" " -7 if-(J 7 2S
Signature Date
Print Name:
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