HomeMy WebLinkAbout3040 Anchor Way - Applications/Reroof - 04/08/2019 (3)City of Planning, Development, & Transportation Services
�t Codlln$ 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 # h infl owl Date
)W o>rlc use only
Job Site Address (requfed) Value of Construction (labor, materials, proms �y
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Property Owner Name Address City/State Zip Phon
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Applicant Name Address City/State ip Phone
�^ tractor Address dity/S te Gr ip Phone S_
FS,ales
ontractor City of F�Collins Sales Tax # Are you paying taxes her r by report? Here ❑ Report
0Ina by all contactors Are you paying with your trust account? ❑ Yes ^No
Is this a residential or commercial project? Reside tial ❑ 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 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 e -- r
6
*If lawn sprinkler/backnow 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# R (xiGLC'
Electrician Plumber Mechanical Roofer y 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: 1�1 %I46 % � `
Print Name• /(/� / t 6 Signatu Date
Revision date M2017
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