HomeMy WebLinkAbout2302 Chandler St - Applications/Reroof - 07/24/2019City of Planning, Development, & Transportation Services
F6rt 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 wi I not be accepted.
Application # l�� c���CQ Date
For office use only
Job Site Address (required) value of Constr ction (labor, materials, profit)
Property Owner Name Address City/State 1p Phone
Applicant NaVte Address City/State Zip Phone
�4, 6��1` o��sZ cp-,, � �d �oG3 — �Zv Sfl r
Contractor Address City/State iip Phone
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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 o commercial project? ❑ Residential ❑ Commercial
If residential, is it: RSingle 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 SO years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of w rk j /4 e Y i �D
Cv it i Gr�'P/
e
*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: ^ / i,
Print Name: r Signatu �u�' Date �D` _(a
_,
Revision date 2/612017