HomeMy WebLinkAbout3039 Anchor Way - Applications/Reroof - 04/09/2019Fcity of planning, Development, & Transportation Services
ort 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 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 # btgou30 Date A .' h
B
For office use only
Job Site Address (require Va ye of Construction la� mat profit /7
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Property Owner Name Ad ress City/State Zip Phon
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Applicant Name Address City/State ip Phone
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�^ tractor Address dity/State C jt ip Phone
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Contractor City of FtJCollins Sales Tax # Are you paying taxes her r by report? Here ❑ Report
Sales lax number is required bya//contractors. Are you paying with your trust account? ❑ Yes ^No
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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? ❑ 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 ` 6
*If lawn sprinkler/backflow preventer, must list licensed plumber. I i st-time A/C, must fist licensed electrician.
to Subcontracrs: List the company name or City of Ft Collins license# At ,
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Electrician Plumber Mechanical 4 Roofer % r 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 slate laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: r DPrint Namet e al s Signatu
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Revision date 2162017
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