HomeMy WebLinkAbout6415 Buchanan St - Applications/Reroof - 08/31/20110-ty of
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Planning, Development ixTranspob Cation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax,224-6134
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This application is to be used to apply for the following permits only (check all that apply). 0 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. Incomplete applications will not be accepted.
Application #?>AAD U7— 1 % pat:? _ 0-?/ //J/
For office use only t3
�Jo Site Address (required) 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
!1641'e 323oT-76f-
Contractor Lic # R-J_11/ Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here "or by report?
Gi 4re ❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or�cop�Kercial project? YSResidential ❑ Commercial
If residential, is it: [2 Single 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 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 #
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 issued.
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Applicant: _ V- ��3 L
Print Name: Signatur - Date
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