HomeMy WebLinkAbout2273 Silver Oaks Dr - Applications/Reroof - 04/11/2019City of Planning, Development, t& Transportation Services
Fort 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 I I I D
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 # N _ "� A �3 `l Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)'
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Property Owner Name Address Clty/State Vor� Zip $OS,Io Phon q10
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Applicant Name Address'�.AN- F ,a City/State �oc, Zip Phone
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Contractor �3-165 Address City/State G,1 Zip ajo\j a Phone lot
Contractor City of Ft. Collins Sales Tax # Are y u paying taxes here or by report?' °A Here ❑ Report
salesiaxnumberisrequiredbyailcontradnrs Are you paying with your trust account? ❑ Yes [\No
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Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: l KSingle Family Detached ❑ 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 "o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of wor- c ,
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0 is,, (�o �t (-,L�_
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:am'A
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Print�Ne:,XV-tA_ c Signatur� Date
Revision date 2MO17