HomeMy WebLinkAbout409 E Prospect Rd - Applications/Reroof - 06/03/2019Planning, Development & Transportation
city
{Of „ 281 N. College Ave P.O. Box 580
24
FQr 1. Collins IS Fort Collins, 16 2740
6r Phone gins, C 805 Fax 2246134
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 Vtoofing ❑ 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 # Date 111 W I q
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
L .Pros cc
Address City/State Zip Phone
Property owner Name J' -J&
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Address City/State Zip P hone
Applicant Name 1
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Address City/State Zip Phone
Contractor o ) �_���
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Contractor City of Ft. Collins Sales Tax #
sales w number is required br all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑, Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office El Office ❑Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work =
*If lawn sprinkler/back low Rventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Co//ins license #
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:
Print Name 1 n Q Q S q �i �. Signature
Date `# )� ) 1 I
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