HomeMy WebLinkAbout6401 Buchanan St - Applications/Reroof - 09/08/2011YI ana9ing, r �PeJopaa� int 7aaia ps7azabi:aa?
� i"ty r:+f.;,,, 281. N. College Ave P.O. Box !i$0
r gW Fort Collins CO 80524
Piton, 970 416-2140 Fax 2.2'( EiJ.?d
1,11is application is to be used to apply for the following permits only (check all that apply). EA Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑Gas Log
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❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement kRoofing ❑ Sewer Line ❑ Photo voltaic
0 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 # l4y Date—__g.LL-- —. --•
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
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City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Lic # Q 0I Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # .
Are you paying taxes here or by report? JeHere ❑ Report
sales tax number is required by all contractors.
Are you paying with Your trust account? ❑ Yes ❑ No
Is this a residential or commercial project?. C61Residential 0 Commercial
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garag&
If commercial, is it: ❑ Bank ❑ Bar . O Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? EIYes ❑ 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
*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 9
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 state laws regulating building construction. I know that a
permit is not valid until it has been paid and issu2fl,