HomeMy WebLinkAbout3665 John F Kennedy Pkwy - Applications/Reroof - 09/24/2012Cit f Planning, Development & Transportation
c %r o281 N. College Ave P.O. Box 580
6 _! rt Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY C�34 1 cS
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
Application #
For ofce use only
Incomplete appli tionsill not be accepted.
Date t
lob Site Address (requir d)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Pf Here .❑ Report
SalesTqeris uir�dbyall mntractom
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential $ Commercial
If residential, is it: ❑ Single Family betached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office Nwffice oW Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes I� No 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.
Description of work
A ._. . .. _
*If lawn sprinkler/backFlow 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
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 to laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
RICHARD M. COHEN, PRESIDENT
COLORADO MOISTURE CONTROL, INC.. /
Applicant: I
Print Name: Signature Date `
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