HomeMy WebLinkAbout629 Mathews St - Applications/Reroof - 04/02/2019City of Planning, Development, & Transportation Services
Fort Collins CommunityDevelopment & 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 Ki2oofing ❑ 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
�ntonthe application. Incomplete applications will not be accepted.
Application #I /U9�Date 2 �2oi '/
For ofce use only
Job Site Address (required) Value f Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name /1 k_s ,, f&s..,�+ddress City/State Zip Phone
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Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? here ❑ Report
sales tax number &requIredbyall amractors. Are you paying with your trust account? Yes ❑No
Is this a residential or commercial project? C,'id2esidential ❑ 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 (exp in)
Is this building 50 years of age or more? ❑ YesNO Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building mnstructed?
Description of work 4'va /3rLlo�Ac-c z3- SQ oP A-rPr-Ae+rStf.,16��
*If lawn sprinkler/barkflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cty of Ft Collins /irmse fi
Electrician Plumber Mechanical Roofer Other
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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 \ II
Print Name: MJ/E1= Gr"-S ) � bf4w) slgnature Date
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