HomeMy WebLinkAbout543 E Saturn Dr - Applications/Reroof - 07/30/2019City of Planning, Development, & Transportation Services
.City
Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.4162740 Fa:c 970224.6134
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 #. i10 D M I Date 1 `0AC)
For office use only
JIoblsiie!p�Idr6s (required) Value of Construction (labor, materials, profit)
DY- EUA CUllivis (,0 SDSaS 'I ISC)
Property Owner Name Address j City/State Zip Phone
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Applicant Name Address City/State Zip Phone
kI n I-Cnv of E fAAI l e b oV} coltvos, W W)sa onD - (-)WRQ63
Contractor I Address City/State Zip Phone
6,VYIM 5&46 CMADDYAA�
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by allmntractors. Are you paying with your trust account? Fl Yes ❑ No
Is this a residential or commercial project? KResidendal ❑ 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)d No If yes, you may need to contact HistoncPreservation
If this is for a demolition permit, what year was the building constructed?
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*If lawn sprinkler/backfiow 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 Rooferkkn 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: 3
Print Name:' "M :nM1 A"ignature]JAL Date
Revision date 2/612017