HomeMy WebLinkAbout3100 Anchor Way - Applications/Reroof - 04/08/2019Fcity of Planning, ®eveiopment, & 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 Roofing ❑ Seaver Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable info ation on the ppplication.
Application #
For ofce use only
Incomplete applications will not be accepted.
Date �' �®
Job Site Address (required) Value of Construction (labor, mate ' Is, profit)
1 r ZF+C�l� s Cv J 1/;2c7
Property Owner Name dress City/State Zip Paa3-�go2
Acho a r4 d yt6wM0 sf Axm c SQ
Applicant Name Address City/State ip Phone
r•f; tractor Address Pity/State C/WrA1wp Phone
374 - # a i s �?®// 0
FContr:-ac�tor City of AJCollins Sales Tax # Are you paying taxes her r by report?Here ❑ Report
a/es umber is required byall mntractors Are you paying with your trust account? ❑ Yes /1!�No
Go /379'7 y
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? ❑ Yes'XNo 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 NOSS 4, 50r 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 # Ass t ` CGYIIL(C` (}-
Electrician Plumber Mechanical Roofer 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: J/%,� t �/// �% %
Print Name:/U��e Aa/ P� - Signatu ��Dat�eoS /
Revision date 2/62017