HomeMy WebLinkAbout3224 Pepperwood Ln - Applications/Reroof - 06/04/2012Jun 04 12 12:52p terry
9705872178
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FOCity. Collins
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). 0 Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Ilo 33� Date
For office use only
Job Site Address (required)
,� [Value of construction (labor, materials, profit)
I. $
�s
d�
Property Owner Name Address Ci State
7 �'/ . Zip Phone
Applicant Na � Address sty/State
C Zip Phone
i ���Cs y r
Contractor �L' # Address
Cy/State Zip � Phone
- �6
Contractor City of Ft Collins Sales Tax # poh
Are you paying taxes here or by report? ❑ Here e Saleslarnumberlsrequiredbyallmntractors Are you paying with your trust account? ❑ Yes ❑
Is this a residential or co mercial project? 9(gesidential ❑ Commercial
If residential, is it: +ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
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 ❑ No If yes, you may need to CDntW t fijgb',ic Preseruabon
If this is for a demolition permit, what year was the building constructed?
Lfprior to 1975, you will need an asbestos assessment to submit with this apPIGc &on.
Of
*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 jqt Collins licen50 #
Electrician Plumber y
Mechanica!_�_ 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 state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant -
Print Name: Clef Signature �t�'—f 7
Date