HomeMy WebLinkAbout6025 Venus Ave - Applications/Reroof - 07/13/2012City of
F„` rt 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 ❑ 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 informatiop on the application.
Application #
For office use only
Job Site Address (required)
Jcyut Ave- FC-Ao
Incomplete
Date I
will -not be accepted.
Value of Construction (labor, materials, profit)
�,. _
Property Owner Name Address
City/State Zip
Phone
(:trod L�k 14W.,,� es ,nna�t
g 3's 6%HL
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
STowoo Ocd- N stOy
N-c..t1:3 FL CU Y0.Szq
26(,
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ji$ Report
Sales tax number isrequiredbyall mntractom
Are you paying with your trust account?
❑ Yes ❑ No
yy 6 53
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: ,0 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, you may need 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.
Description of work (Zc.� s,n3G -.6 � ,, _ z NJg] 0 c- a30
*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
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: n ` (1 O I I
Print Name: Kobe ru Signature i�M Date 7` (3- I �-