HomeMy WebLinkAbout804 Gallup Rd - Applications/Reroof - 05/28/2019Frcof
t Collins
pranrung, uevcrupmaut m 1 , auapv, •auwj
281 N. College Ave -P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
®VEIL -THE -COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement Aoefing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicOl ``information on the application. Incomplete applications will not be accepted.
Application # i 1 �lC�?� a` Date MnLj_ a�B,XN1
For office use only —i
Job Site Address (requlred) Value of Construction (labor, materials, profit)
e04 GICIIIJ-rn'Rd $ L15ft . =
Property Owner Name Address
City/State/
Zip
Phone
. F all) t.0.
8115g4 q-0-411,-
Applicant Name Address
citylstate
Zip
Phone
Contractor Lic # 1�� 1—l$3 Address
City/State
Zip
Phone C}-10
' o q-:�8 1 i`\C`f` : U n
U--L e FT'C.
C(D :5C7f:'ZL1
ZZA-mco
Contractor City of Ft. Collins Sales Tax # y I j-}Lp
Are you paying taxes here or by report? ❑ Here
Af Report
Su/es tax numberfs wqulredbyall conbWdom
Are you paying with your trust account? J# Yes
❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage -
If commercial, Is it: ❑ Bank 17 Bar ❑ Church ❑ Hotel/MoW ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
IS this building 50 years of age or more? ❑ Yes ❑ No rf yes'you mayneed to contactHIstoryc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you wl/l need an asbestos assessment to submit with this application.
Description of work 7COa.2 - _4&, rode 'h) CIOQJ-V1n n 7OZ'Cs� w 11 C1raSS
Ln.rrtL I Sc„riv.es 18.(sL,
` 11' lawn spdnkier/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed el cbidan.
Subcontractors: List the company name or aty of Ft cbllinsllcense #
Electrician Plumber Mechanical Roofer A I t iQ Yf ,�- ., Other
I hereby acknowledge that I have read this applicatl6h 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 itt has been jpaid and issued.
Applicant.r1%�Cl<G V FJ. ci8. IQ
Print Name: Signature Date
-TtU57 Nc.00Lv1 '