HomeMy WebLinkAbout903 ELGIN CT - APPLICATIONS - 8/2/2018Aug 02 18 03:28p Severe Weather Roofing 9702233383 p.4
SCity of Planning, Development, & Transportation Services
oft��ins 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 Lghter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (m,ust be EPA certified: provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 6 l q)oy)l 1911 Date
For of3rce use only
lob Site Address (required) Value of Construction (labor, materials, profit)
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(Property Owner Kame Address City/State Zip Phone
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Applicant Name Ad ress City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? E<Here ❑ Report
S&Ls tax ,wmberisrequired byall cono-acmrs. Are you paying with your trust account? ❑ Yes iZNo
21"212-U -) 5 I
Is this a residential or commercial protect? 9 Residential ❑ 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? ❑ YesjdNo If yes, you may need to contactHlstoncPreservation
If this is for a demolition permit, what year was the budding constructed?
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*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or Giry cf r-t Coffins license # , t
Electrician Plumber Mechanical Roofer . � F r �r 1 u47' Other
I hereby acknowledge that I have read this application and state that the above informatior is complete and correct. I agree to
comply witt 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: Signature •C�-v� - l/ G'I.GP/�� Date
Print
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