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HomeMy WebLinkAbout1874 Indian Hills Cir - Applications/Reroof - 09/04/201209/04/2012 03:39 3032384051 INTERSTATE ROOFING PAGE 23/34 -ity of Planning, Development & Transportation Flirt Collins For 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 0 Lawn Sprinkler ❑ Mobile Home replacement l3 Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater 0 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 # 13I0q0 5or o>�re use only Date 130.93' . Job Site Address (required) Value of Construction (labor, materials, profit) ` / i `�iayL Property Owner Name Address City/State Zip Phone oo l r4 C01 -►�SCD 5 -- Selo -�9 Applicant Name Address City/State Zip Phone Co 5g_> 8 Contractor Address City/State Zip Phone Co -Ja)S=y Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?c2'tiere ❑ Report Sales tax number is required by all contractom Are you paying with your trust account? ❑ Yes ,-I No Is this a residential or commercial project? r5, Residential ❑ Commercial If residential, is it: ❑ Single Family Detached _Condo/townhome (single family attached) 0 Duplex ❑ Multifamily (apartment) ❑ Garage If Commercial, is it: ❑ Bank ❑ Bar IJ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 13 Retail © Restaurant ❑ Other (explain) Is this building 50 years of age or more? L l Yes tPAo If yes, you may need to contact Historic preservation If thi5'is for a demolition permit, what year was the building constructed? If pnor to 1975, you wi/l need an asbestos assessment to submit with this application. Description of work r") *If lawn sprinkler/backfiow 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 17 8 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:�-�+.11 j Print Name: �]c A OU.4__ -'sr Signature Date 9 1 w I i Z-