HomeMy WebLinkAbout311 S College Ave - Applications/Reroof - 07/30/2012Fort of
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 information on the application. Incomplete applications ill not be accepted.
Application # ab4 c.�-7 9 Date 75.�
For office use only
Job Site Address (required) Value of Constru on (labor, materials, profit)
lJ Sou'tIti 00
Property Owner Name Address
City/State Zip Cp�o�n49_ Z7
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
9--s-4 1 z 13+tAe_ oez.
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
ere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential UrCommercial
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 5o years of age or more? ❑ Yes o 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.
of work
r
YL.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-ti A/C, must list licensed electrician. Ott_ gCw
Subcontractors: List the company name or City of Ft Collins license # C6 I' l ( Dp-
Electrician Plumber Mechanical Roofer 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:
Print Name: Signature Date
7