HomeMy WebLinkAbout760 Eastdale Dr - Applications/Reroof - 04/29/2013City Of Planning, Development & Transportation
_ Fy 281 N. College Ave P.O. Box 580
6rt Collins f r) 5 `l S 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 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 applicati ns wil not be accepted.
Application # �f� (C��. Date Zg
For offlce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
760 _aSf J Q l e $ 2 &I&D
Property Owner Name Address
Ci /State
Zip
Phone
p"pliicant Name / Addrrees^s�
A(j�
City/Staat�e
A//,/"
Zip
Ph`one
Contractor Lic # Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes
Are
here or by report? c®-Here ❑ Report
❑ Yes C"o
5alestax number isrequiredbyall contractors.
you paying with
your trust account?
Is this a residential or commercial project? k&Residential ❑ Commercial
If residential, is it: dingle 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? O Yes qir-No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
,-k .?/-) u r
.5
l
*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 # Q �%
Electrician Plumber Mechanical Roofer / L/ / 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: Z I
Print Name: ' G� Signature Date