HomeMy WebLinkAbout2701 Stover St - Applications/Reroof - 10/10/2012OCT/10/2012/WED 01:34 PM FAX No, F. Oct
C ity of
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 58o
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). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo -voltaic
El 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 #_F),I aolvolog _ Date
For office use only 14a
.lob Site Address (required)
Value of Construction (labor, materials, profit)
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Prro�perrtyOwnnerName
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Address/ City/State Zip Phone
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Ap�jpp�lliic�cant Name Address City/state Zip
Phone
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Contractor
Address cty/State Zip
Phone
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Contractor City of Ft. Collins Sales
Tax #/.,Are you paying taxes he er or by report? Here
lS
❑ Report
sales tax number i'erequiredbyall conrracnoU Are you paying with your trust account? ❑ Yes
No
Is this a residential or commercial project? 0 Residential 40 Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Er 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 11 No Ifyes, you maypeed to contactHistonc Preservation
If this is for a demolition permit, what year was the building constructed?
If for
to 1975, you will need an asbestos assessment to submit with this application,
Description of work krs/i
*If lawn sprinkler/backnow 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 a
Electrician Plumber Mechanical Roofer other
I hereby acknowledge that Ihave 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 Nam
Pate 1 eo r ,
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