HomeMy WebLinkAbout3103 Moore Ln - Applications/Reroof - 04/24/2013City Of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement bdRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). r ,,
Complete all appli a i * form t'T
o the application. Incomplete appli atjo/n� ill not be accepted.
Application # T' I �Ill// Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
.3/03 Aye & $ 574M
Property Owner Name Address
City/State
Zip
Phone
U l �Y103 Ajore Z ?
CO
eas2tll
Zz3-3330
Ap licant Name Address
City/State
Zip
Phone
Contractor Lic # Address
dirya J 1(270 3q 33
City/State
27
Zip
$05/3
Phone
612- 6L o
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 0 Here ❑ Report
5aiestax numberisrequired byall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: mingle 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.
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.
Applicant:
Print Name: Signature Date /