HomeMy WebLinkAbout2403 Rock Creek Dr - Applications/Reroof - 07/29/2019City 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 Sto a (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # GP 0 59 1 a_
Foroffice use only
Incomplete applications will not be accepted.
Date
of
Job Site Address (required) Value onstruction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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A p ant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone L'�)!>r
Contractor City of Ft. Collins Sales Tax # 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? ❑ Yes ❑ No
Is this a residential or commercial project? YtResidentiai ❑ Commercial
If residential, is it: ❑ Single Family Detach d ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (exp)ain)
Is this building 50 years of age or more? ❑ Yes gMo Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work G
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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_ 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: q !�
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Print Name: Signature Date
Revision date 252017