HomeMy WebLinkAbout2815 Sternwheeler St - Applications/Reroof - 04/01/2019Planning, Development & Transportation
��'''' City Of 281 N. College Ave P.O. Box 580
FOt t CollinsllFort Collins, CO 80524
Phone 970-416-2740 Fax 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 serve a change) ❑ Gas Lighter El Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Woofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable mf r�tign o the application. Incomplete applications will not be accepted.
Application # 1 UU 11II 1 I `J Date
For o rce use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
i City/State Zip
Phone
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Applicant me Address
City/State Zip
Phone
Contractor Address
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City/State Zip
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Phone
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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_co erdal project? residential ElCommercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑Zn
otel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑Other (exp
Is this building 50 years of age or more? ❑ Yesf yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn
preventer, must list licensed
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical
A/c,
ist list licensed electrician.
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Co bc03
Roofer Co (U% . 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:/ UL4- aJ (YCC ti signature Date ( ( C
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