HomeMy WebLinkAbout3012 Anchor Way - Applications/Reroof - 04/08/2019 (2)City of Planning, Development, & Transportation Services
®rt®l�1n$ 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 XRoofing ❑ 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 # ?D � vl D I Date
For office use only
Job Site Address equired) Value of Construction (labor, merials, profit)
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Property Owner Name Address City/State Zip Phon
Applicant Name Address City/State ip Phone 3
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r*^ tractor Address ity/State G7�� ip Phone_
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Contractor City of Collins Sales Tax # Are you paying taxes here4ir by report? Here ❑ Report
Sales lax number is required by all contractors. Are you paying with your trust account? ❑ Yes /)!�No
Go 1375 7c/
Is this a residential or commercial project? Reyside ❑ Commercial
If residential, is it: ❑Single Family Deta ed 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? ❑ YesXNo Ifyes, you may need to contact HistoricPreservatlon
If this is for a demolition permit, what year was the building constructed?
esScri tion of woro rk, e S r 6
*If lawn sprinkler/backflow preventer, must list licensed plumber. I rst-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license# A� xCclii�v�
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: I ite % r�� �� g
Print Name: % Si natu 9 veg&�: Date
Revision date 2fe2017
160-7