HomeMy WebLinkAbout2918 Silverplume Dr - Applications/Reroof - 07/12/2019 (8)Planning, Development, & Transportation Services
FOI"t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 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 0 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 #_ Ivl 5 s`s Date q % lZ I
For ofFce use only
Job Site Address (requiredl Value of Construction (labor, materials, profit)
a°I ►� S�l of C: cl For-y catIAs . 1,13N
Property Owner Name AddreJ City/State Zip Phone
lam�n 115- tart ; For 1 n CO. a9_0 - 3
Applicant Name Address City/State Zip Phone
SAM Co IV: oto1S S. Pvnlhko LJ Co. o2 3o3- so-4- 6oy
Contractor Address City/State Zip Phone
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Contractor Citiyf Ft. Collins Sales Tax # Are you paying taxes here or by reporg Here ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? ❑ Residential rf4 Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Iffi 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 x No /fyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
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*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 60r79W 67f, lOther
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: ��/ /„
Print Name: r�7�Signature ✓ ate 7/1ZJ19
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Revision date 2/6/2017