HomeMy WebLinkAbout1846 Indian Hills Cir - Applications/Reroof - 09/04/201209/04/2012 03:39 3032384051 INTERSTATE ROOFING PAGE 13/34
Planning, Development & Transportation
Faryt Collins For N. College Ave P.0- 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 L Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 17 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 # -61 ""c 31 W
For ofce use only
Date 1 L)0.L13. 1.
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Properly Owner Name Address
City/State Zip
Phone
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9Z-5'07-M
Applicant Name Address
City/State zip
Phone
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720 3 8
Contractor Address
City/State Zp
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?cam lere ❑ Report
Sales tax numberisrequiredbyall contractors.
Are you paying with your trust account?
❑ Yes L-JqNo
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? (Residential ❑ Commercial
❑ Single Family Detached c5a:1:ondo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes Imo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Rt r cx7 -A?✓t j
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the Company name or C/ty of Ft Collins license #
Electrician Plumber Mechanical Roofer 17 $ 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-
PrintName:TAA DkL" Signatur Date