HomeMy WebLinkAbout303 Triangle Dr - Applications/Reroof - 07/09/2012A
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13144999040
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Fort Collins
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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 9Roofing ❑ 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. e
Application # . 9 I 30"'LL1,M)" L4 I ff I Date �y L ' `i Z C' I Z- "
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
50.� ..FK lAm (ate 'Pin,Ivly r.'
44
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
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Contractor C /� Address
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City/Stat Zip
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? A Here ❑ Report
sales tax nu is required by all contractors.
-Are you paying with your trust account?
❑ Yes )R No
Is this a residential or cpmmercial project? PO Residential ❑ Commercial
If residential, is it: t9 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 §CNo Ifyes, you may need to contact Historic Preservadon
If this is for a demolition permit, what year was the building constructed?
Ifptior to 1975, you will need an asbestos assessment to submit with this application
Description of work
P,
*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 0
Electrician Plumber _..,--._ Mechanical RooferOther
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: 1`
Print Name: Sc%,soN wt tie Signature
Date -4 1 0 1 2
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