HomeMy WebLinkAbout3024 Marina Ln - Applications/Reroof - 04/08/2019 (3)FCity of Planning, Development, & Transportation Services
ort CoRin$ 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 oofing ❑ 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.
Appli..tbon #_Qbj01 bDate
r office use only
Job Site Address (required) #� V lue of Construction (labor, materials„profit)
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Property Owner Name Address City/State Zip Phon
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Applicant Name Address City/State ip Phone
c^ tractor Address ity/State C/W ip Phone ::-;I
8 -M:6 U#703 Mmci?'®/l
Contractor City of AJCollins Sales Tax # Are you paying taxes her r by report? Here ❑ Report
Sales tax number rsrequired byall mntradors Are you paying with your trust account? ❑ Yes Xlo
Go 137R 77
Is this a residential or commercial project? Reside tial ❑ Commercial
If residential, is it: El Single Family Deta ed yCCondo/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 Ifyes, 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/backflow preventer, must list licensed plumber. I rst-time A/C,. mu /� list licensed electrician.
ist Subcontractors: Lthe company name or City of Ft Collins license# ASSe_rat
aotli ra, '}ems
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete andl 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:
Print Name: l� 1�1 %llre
Signatut0e�t_Date
Revision date ?l6l1017
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