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HomeMy WebLinkAbout2407 Kodiak Rd - Applications/Reroof - 07/26/2019Plann���, ©�v����� r� , s 6 rr r�sl®oe �r ic��u Services ���®���� Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 90624 Main: 970,4162740 F.ax: 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 # -ligl) 6054it Date ` .496 /9 Fo offce use only Job Site Address (required) Value of Construction (labor, materials, profit) 17ct 1O. 00 Property Owner Name Address City/State Zip Phone o 5a 9-7-aa340C)a-Z Appllciht qme Address City/State Zip Phone C c LeXe "57 q-1D, i—lni"7 Contractor Address City/State Zip Phone Contractor City of Ft. Collins a s Tax # Are you paying taxes here or by report? Here ❑ Report Sales tax number isrequlredbyall contractors, Are you paying with your trust account? K.Yes ❑ No d!IOtt I Is this a residential or commercial project? g Residential ❑ Commercial If residential, is it: 1 Single Family Detached ❑ Condo/townhome (single family attached) El Duplex ��jj 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 No If yes, you may need to contact Historic Preservation he If this is for a demolition permit, what year was building constructed? Description of work riaD�. T ie� c t'g a. S T *If lawn sprinkler/backfiow prevente , ust 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 K - NOW 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: Print Name: eA` wtct- MW6 Signature Date . �7101LOI�I9 Revislon dale 2/6/2017