HomeMy WebLinkAbout506 11th St - Applications/Reroof - 07/30/2018FCltyOf Planning, Development, & Transportation Services
, -. port 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) El Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler El Mobile Home replacement ISa 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 t b
Application # 12) V bD Q a 0S
For ofce use only
Job Site Address (required)
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no a accepted.
Date
Value of Construction (labor, materials, profit)
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P operty Owner Name \ Address City/State Zip Phone
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Applicant me Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales taxnumberIsrequired byallcontracrors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: W Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, i5 it: ❑ Bank ❑ Bar ❑ Church 0 Hntel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑Other (explai
Is this building 50 years of age or more? ❑ Yes W14o 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 y C
yn
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must, jjslicensed electrician.
Subcontractors: List the company name or City of Ft Collins license # OV
Electrician Plumber_ Mechanical Roofer Other
[permit
ereby acknowledge that I have read this application and state that the above information is complete an correct. I agree to
mply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
is not valid until it has been paid and issued.
plicant:rint Name: 1'� Signature —z_.' Date
Hedsion dat, 2/6/2017