HomeMy WebLinkAbout1506 Bayberry Cir - Applications/Reroof - 09/18/2012Sep 18 12 08:08a
PA
City of
�t 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 information own the application. incomplete applications will not be accepted.
Application # en'�o S5 I / Date
For office use only
]ob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Nam
Address
City/State Zip
Phone 4?o
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Applicant Name
Address
City/State Zip
Phone e?-7(5
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Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sa/es Mrnumber&re Ared by&#cwftwtors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 10 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 C No Ifyes, you may need to contact 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 wig this application.
Descript'iron of work 2.e o e 4 v�� r-� lac �X �-i vC r=4
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*If lawn sprinK(er/badfflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Crty of Ft Collins t�cense #
Bectridan 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 arid state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
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Applicant: r. ', l l
Print Name: 1.� i ��c,sl.l.l1 i Signature �,1:,�% Date �'7 ((� f 2