HomeMy WebLinkAbout3543 Tradition Dr - Applications/Reroof - 07/20/2012Jul 20 12 10:00a
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ort 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). Q Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 13 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 # 310-2Q - r q3S Date
For of e use only
Job Site Address (required)
Value of Construction (labor, rnateriats, profit)
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Property Owner Name
Address
City/State Zip
Phone 'q 70
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Applicant Name
Address
City/State Tip
Phone q-7c
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Contractor
Address
City/State Zip
Phone
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Contractor City of R. Collins Sales Tax
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Are you paying taxes here or by report? ❑ Here ❑ Report
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Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? 1M 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? ❑ Yes ❑ No If yes, j ou may need to mnmct Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
of work
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*If lawn spiWnIdWbaddlow preventeemust list licensed plumber. If first-time A/C, must fist boansed electrician.
Subcontractors: List The company name or city of Ft Co&w license ,#
Electrician Plumber Mechanical Roofer
Other
I hereby adviowledge that I have read this application and state that the above infonmtion is complete and correct. I agree to
comply with an requirements contained herein and city ordinances aAd state taws regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
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Applicant:/� titLh` ' t
PrIntName: Yt1'kd V'l.f.i'tc,1', Signature �� ,�i�U��. Date i��IIZ