HomeMy WebLinkAbout5809 Plateau Pl - Applications/Reroof - 06/24/2019City of Planning, Development, & Transportation Services
Fort Collins 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 applicable information on the application. Incomplete applications will not be accepted.
Application # 'D 1 l UN (D-S
For office use only
Date 6"Zq '
lob 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
Contract r Address City/State Zip Phone
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City City of Ft. Collins Sales Tax # L1 1 3') 4 Are you paying taxes here or by report? ❑ Here Report
Sales tax number is required by all contractors Are you paying with your trust account? OYes No
Is this a residential or c mmercial project? ,gResidential ❑ 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 ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 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?
Description of work TPnr W +U dPPKIYIU c-eo ace kk)/ c%kosS <1 -:a2m42n .-F YPRt�ldl�
*If lawn sprinkler/backflow 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 I W8_Y-e_F 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: ')(� n /�
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Print Name: `-' Signature Date
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Revision dale 2/812017 V