HomeMy WebLinkAbout2200 Valley Forge Ave - Applications/Reroof - 05/03/2013Cityof Planning, Development & Transportation
} 281 N. College Ave P.O. Box 580
FOrl CollinsIFort 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 applications will not be accepted.
Application #
For office use only
Date 5 — S — I �> -
Job Site Address (required) Value of Construction (labor, materials, profit)
70
Property Owner Name Address u, ,,; I.s
I — y City/State
Zip / phone
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Applicant Name Address
City/State
Zip Phone
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Contractor Lic # Address
5-mrrcl
City/State
Zip Phone
5 o r� o� 12—a�i� ��i ILr
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes
here or by report?Here ❑ 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? Wesidential ❑ Commercial
If residential, is it: I$ 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 O 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 I ow I L�E� r�
�O Vv:,i n1m. r7�,r,alc��
*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: L �.-c, n LZ
Print Name: k � �` �L Signature r✓l,z�-. Date