HomeMy WebLinkAbout2809 Mercy Ct - Applications/Reroof - 06/27/2019c;ty Planning, Development, & Transportation Services
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 applic le Information on the.p Iication. Incomplete applications will not be accepted.
Application # �� °� Date L e-77- e5pvlO
For office use only
Job Site Address (required) _ Value of Construction (labor, materials, profit) al Cw,
01
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Property Owner Name' I Address City/State Zip Phone
J I ffu o riK c�5'3G — a 7
Applicant Name Address City/State Zip Phone
3 77--70?3-30(5
Con actor Address City/State Zip Phone
e Hl s'3 -
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or coromercial project? Residential ❑ Commercial
If residential, is it: RiSingle 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 So years of age or more? oYesl2lqo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description o ork
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,a
*If lawn spri kler/bac0ow 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
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 dty ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
A trd' �' 7- 0�019
Prilicant: nt Name:�e_�d� Signature Date
Revision date 2/6120V