HomeMy WebLinkAbout416 10TH ST - APPLICATIONS - 7/9/2019City of
Fart Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 ff 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 infformattionp oon, Vthe application. Incomplete applications/will not be accepted.
on
Application # I �' 1 1 I 's- Date
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
416 loth St, Fort Collins, CO 80524
$1700.00
Property Owne Address 416 loth St.
City/State Zip Phone
Namer
Ft. Collins, CO 80524 970-834-1715
Minh Nguyen
Applicant Name Address
City/State Zip Phone
Jonah Lovendahl 1713 E Lincoln Ave. B-3
Ft. Collins, CO 80524 970-493-2801
Contractor Address
City/State Zip Phone
ACC Roofing, Inc. 1713 E Lincoln Ave. B-3
Ft. Collins, CO 80524 970-493-2801
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ffHere ❑ Report
Salestylry/gberisrequired byall contractors.
Are you paying with your trust account? ❑ Yes ffNo
Is this a residential or commercial project? Lf Residential ❑ Commercial
If residential, is it: CfSingle 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 CENo Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
asphalt shingles, 17 squares
*If lawn sprinkler/backfl W�oi5didtdlec
Subcontractors: List the company name or City of Ft Collins license #
Electrician
Mechanical Roofer R-1819 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: Jonah Lovendahl
Print Name: Signature 1/ Date