HomeMy WebLinkAbout2139 Fossil Creek Pkwy - Applications/Reroof - 06/20/2019FCity of Planning, D'erreladpn7ent, & Transportation services
ort Collins CamMr1i* Develop � � ett & Ndghborl ood Service
ear Nar6h, Gblleg a Arienue
Fort Cbilh-W,COdW524= ftairtz 97@P�-16M41Fax: 5TQ:224i6,134.
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 fXRoofing ❑ 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.
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Application # � I "110q_3:�q Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip / Phone
Contractor City of kCWollrimsEales ax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number rsrequired byall contractors. Are you paying with your trust account? �es ❑ No
Is this a residential or co merdal project? [.Residential ❑ Commercial
If residential, is it: J& Single 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 (expI.n)
Is this building 50 years of age or more? ❑ YesZo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Dggsscn tion of work {�10(I VP-VOO jAAl q DS 93k pf-�f- A-nnoiskftIJ II
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*If lawn sprinkler/baddiow 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 Roofer Other
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 q��"�
PrintName:/�nUVI: 1 1&VVVWLL Signature Date 1p
Revision date 2WO17