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HomeMy WebLinkAbout1501 Briarwood Rd - Applications/Reroof - 04/25/2019City of Planning, Development, & 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 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 ❑ 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. Application # QL For office use only Incomplete applications will not be accepted. Date LA 12 a 12611 Sob Site Address (required) Value of Construction (labor, materials, profit) 1561 By iav wood 94 .,1 z33. L'�6 Property Owner Name Address City/State Zip Phone 1 am clxw u V) (Sol By anwool 9d Fo if Ca((m CQ 910 493- T55f Applicant Name Address City/State Zip Phone M-e; 0J) l Co 0-5 aO W vd U IrykWi i QL 050 f -A �q - 21- 36,53 Contractor Address City/State Zip Phone y (ZCcop o 127_5 V-P-0 pvall 3Evd t_cm y WaJ r) &J501 ao3-8z1-3`72-�- LJ Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? j)(Here ❑ Report sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes No .6c)g3g4 13 Is this a residential or commercial project? IYResidential ❑ Commercial If residential, is it: VSingle 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 ( No If yes, you mayneed to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work l'Cy1lt1i1 lCt1 1 .k—VCRC-P ptkZyiS riorn(y)o1 dLk(ofibn Sf Vy\ 1),- 41tw ©� (7?D -s,�y sA�Y �t`1 5���.es *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 # Electrician Plumber Mechanical Roofed),` l "JOther 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- /� 112-5 120 � 1 print fVame: I`r �'�a" F`j � � �fl Signature Date Print Revision date 2/6/2017