HomeMy WebLinkAbout1735 Mathews St - Applications/Reroof - 04/03/2019FoIty °i Planning, Development, & Transportation Services
rt 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 # 18muml Date
For afflce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
35 ,4i 6ws s'(. R 6r 6 S 000
Property Owner Name Address City/State Zip Phone
Ivil 140JOW C6r R..6 YO5-aCq 6-22
Applicant Name Address City/State Zip Phone
5 A-G a o>r n� 6ot, ojc o 217 &&Ym' D �-�. L'of(vns $o!Dq 0 -S('(_ qy1
Contractor �� Address City/State Zip Phone
t% I% I
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? K Here ❑ Report
Sales tax number isrequir�allconbactom Are you paying with your trust account? X Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ 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 more? ❑ Yes ❑ No If yes, you may need to contact Hlstoric Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Wo - ; /N I-fvv '['oTaL. SQ If-7-2-
I NA 1. X Tte it = 61 rc [ 5TvKI G i• �(
*If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, mu list licen ectrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer 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: 1
Print Name: �/fIA� fly L L Signature Date Zzc)
ReAsian date 2WO17