HomeMy WebLinkAbout7330 Streamside St - Applications/Reroof - 07/24/2019i�iivol Planning, ®elleiopment, &1 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 # bl'%Mab Date �/r/ g ho
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
'l o `c1 `$ $
Property Owner Name Address City/State Zip Phone
r o�lc ;� . F`� 9X -
Applicant Name Address City/State Zip Phone
C Mg- T0537 CtV `1-10777
Contractor Address City/State Zip Phone
13oo .1d ro Wa s3i Q7o•( tans- la1ii
Contractor City of Ft. Collins a s Tax # Are you paying taxes here or by report? >�-Here ❑ Report
5alestax number isrequired byall contractors. Are you paying with your trust account? KYes ❑ No
d4Ioyi
Is this a residential or commercial project? KResidential ❑ 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? ❑ Yespo ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 5 C CCg ` cg`tOG s
s `MPS �+{� Cass I U
*If lawn sprinkler ckflow preventer, must list licensed plumber. Ifirs1ttime A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # p ,1
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 city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant, 1.,
Print I ame:T %fL- Signatur Date `Ic�til1 %
Revislon date 2/6/2017