HomeMy WebLinkAbout2901 S Shields St - Applications/Reroof - 06/12/2019l 6Ya
Planning, Development &Transportation
City/ a 281 N. College Ave P.O. Box 580
t CoWns Fort Colrns, CO 80524
Phone 970-416-2740 Fax 724-6134
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 ❑ WoodfPeliet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # a Date
For oflice use only
�- 9
)ob Site Address (required)
090( S i e-(CQJ
Value of Consiruction (labor, materials, profit)
L I Q L I B LLB
� i! Q o7i'l7
Property Owner Name
Address
"
GLy/State Tip Phone
f � d y-e
Disrt r i cd o
o 4'Po rTe E_ C
Applicant Name
Address
City/State Zip Phone
Contractor
Address
ra y/5'tate Zip Phone
C
,QCo 80S_2� gl
&6actior Ctty of Ft. ilins Sates Tax # Are you paying taxes h or by report? 01 ere ❑ Report
I21,0o
salPstaxnumberisrequkadbyasmntractuis Are you paying with your trust account? ❑ Yes
is this a residential or commensal project? I11"keessidential ❑ Commercial
if residential, is it; 0Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ HotelJMotel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, youmayneed to confactHis[arlcPresema6on
If this is for a demolrrdon permit, what year was the building constructed?
Ifpriorta 1975 you coil/naz d an asbestos as 5as smeentta submit mrdh bWsappffab'on.
Description of work
V lawn spriniderlbaddiow preventer, must list licensed
L$
If first-time A/r, must list licensed electrician.
Subcontractors: L&tthemmpanynameorGtyofFt-(alrasrEense# D 7 /�
Electrician Plumber NedmnRZ Roofer Other
I hereby acknowledge that I have read this application and sate that the above information is complete and correct I agree to
comply with all requirements contained herein and city ordinances and slate laws regul_aring building construction. I know that a
permit is not valid until it has been paid and issued.
App6cani: / q
Print Name: 1 _Sign hate