HomeMy WebLinkAbout4924 Smallwood Ct - Applications/Reroof - 07/26/2019City of
�®����� Planning, Development, & Transportation Services
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Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 #
For ofr.Tce use only
Date —1 12 � 1 L9
Job Site Address (required) Vaiese of Construction (labor, materials, profit)
492-4 SIu aQUy upcL W 4byt Col 11176 60152 $ 11 row. I
Property Owner Name Address City/State Zip Phone
a' \*- ACI 6h C%-A a as 404e trio- Zia -qZ85
Applicant Name Q Address City/State Zip Phone
'TQY_0.. OISoYt OW3 . 'QW0oaV1Q 4DCNk0C.LD WL2 LI L01
Contractor Address City/State Zip Phone
Red NambndL� 4so*►t as 0000W &Jame 303 to —u3q
Contractor City of Ft. Collins Sales Taxq Are you paying taxes here or by report? Here ❑ Report
Sales tax number' required byall contractors. Are you paying with your trust account? ❑ Yes [P
Is this a residential or c9rhmercial project? V Residential ❑ Commercial
If residential, is it: L1LSingle 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 (expl in)
Is this building 50 years of age or more? ❑ Yes 9 No If yes, you may need to contact Historic Preservation
If this is for a demolition nermit, what year was the building constructed?
Description Qf work CpALPU:U
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*If lawn sprinkler/back-low preventer, must list licensed plumber. Rf fdpst-t1rrne A/C, must list 9iccensed electrician.
Subcontractors., List the company name or City of Ft Collins license #
5 Electrician Plumber Mechanical Roofer I' v S 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 laws
and state regulating building construction. I know that a
permit is not valid until it has been paid .and issued.
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Revision date 216 2017