HomeMy WebLinkAbout3720 Glenloch Ct - Applications/Reroof - 08/16/2018City 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement hoofing ❑ 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 #6ig06� Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
AID 2 Giev% 1 ocA-N CA- 2 6
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 g7D5q
601 d P. o0-F, n IN, d 2.4E E iStrNh bvff B I d L oNrelO_A Q '906
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? DKesidential ❑ Commercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail I S
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation Y
If this is for a demolition permit, what year was the building constructed?
Description of work wei PAL r 4sil ►� noc+-, ► \zr fM a_ti iY"I`a S 0t,y1 t �
1 n 647it ( Vl e,,0 � I me r�s I err, G s,(�lncx t S K l r� k e Vz 0-ko - -2
*If lawn sprinkler/backflow 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 # i^V^kes
Electrician Plumber Mechanical Roofer JP. 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:
Print Name: Sam lVV 1 II I iAlMeS Signatur I /1� Date ) ��
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Revision dale 2/6/2017