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HomeMy WebLinkAbout1401 Teakwood Dr - Applications/Reroof - 10/10/2012Oct 10 12 10:46a JB Consulting LLC. Fort of 3039974264 p.5 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 servic ange) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne 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. Incomplete applications will not be accepted_ , . ^ Application # 1312D UO3he1 Date V�v( ' For office use only Job Site Address (requlred) Value of Construction (labor, materials, profit) Property yOwner Name Address ) City/StateZip Phone eb — srr �ij m. Y� 141w �G,Q?/ lL i Applicant Name Address City/State Zip Phone q7©- p f- 907,J Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sales raxnumaerisrequlreaoyat/ cwruactom Are you paying with your trust account? ❑ Yes 13 No Is this a residential or com 'al project? l�sidential ❑ Commercial if residential, is it: ERSingle Family Detached ❑ Condoltownhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes o If yes, you may need to mntad Historic Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, you wif/need an asbestos assessment to submit with this application. on of work *If lawn sprinkler/backflow preuenter, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or Cfty of Ft Collin license # Elearician Plumber Mechanical Roofer Other X> 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:i, J 1 %tom . s`t9nantre l dr Date