HomeMy WebLinkAbout334 E Elizabeth St - Applications/Reroof - 08/09/2018City 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 ❑ 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 # lk(� �582 Date 0 .-.2 f5
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
33 y E. 601-A l-T N 51 t-L 9-m'z y G ASS % 0
Property Owner Name Address City/State Zip Phone
T%(V\ ON 3C.-IAVJSEThl $ 71 FTZ, <60G1-
Applicant Name Address City/State ZIP (,3n3� Phone
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1U LA ct c.t F C_ qVS25 1 ?o)Urs -3tsol
Contractor Address City/State Zip Phone
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Noci-h-.,A r Corne,•iTug_Aio/\ I(d-I`t wood CT. FT(, S- 01
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? X Here ❑ Report
sa/es tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? t9 Residential ❑ Commercial
If residential, is it: 0 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 RCMoUL- S HI►aGL IlAS`t AUK to w Fcaj b2lP 1-4w
ILl: WFi-ytg- 5AICA- ctxi%to1IQAA FLPS5,"1MC,S. 2C) 51Q,I2_ 4±f 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 # Q KI N e� S 94r--Ja&-�
Electrician Plumber Mechanical Roofer F-'x - II - Q 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: Olr.n M��VJOD_ Signature Date
Revision date 2/6/2017