HomeMy WebLinkAbout3005 Anchor Way - Applications/Reroof - 04/08/2019 (2)City of Planning, Development, & Transportation Services
.City 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 Woofing ❑ Seever 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 # 61cl D Date
For office use only
Job Site Address (required) Val e of Constructiocl)n (labor, materials, profs
G
Property Owner Name Address City/State Zip Phon
Q ® Y ffl g` .A10 C 8Q as - So2
Applicant Name V Address City/State ip Phone 3
10trArld go °
tractor Address sty/State G P Phone
Contractor City of Al.iCollins Sales Tax # Are you paying taxes her r by report?Here ❑ Report
sales tax number ismquiredbyall contactors. Are you paying with your trust account? ❑ Yes ANo
Go 1378 79
Is this a residential or commercial project? Reside tial ❑ Commercial
If residential, is it: ❑ Single Family Deta ed 0Condo/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?
esscri tion of work S �- r 6
*If lawn sprinkler/backfow preventer, must list licensed plumber. Y rst-time A/Cr must list licensed electrician.
Subcontractors: L& ffie 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 an 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: j� {y i
Print Name:!/�l jte / �/ SignatuZ_
Date o`er
Revision date 7JB2017
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