HomeMy WebLinkAbout2706 Appleton Ct - Applications/Reroof - 05/17/2013City of
/F&t CoR ns
(Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be usefto apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-strmtural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Spri%Rler ❑ Mobile Home replacement )t Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ElWater Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable �iinfo rnation on the application. Incomplete applications will not be accepted.
Application # 04 d 2 Date S 3
For office use mljr , 21 . lY I
Job Site Address (required)
Value of Construction (labor, materials, profit)
.Property Owner Name
Address
City/State
Zip
Phone
Applicant Name
Address
City/State
Zip
Phone
r
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Contractor Lic #
Address
City/State
Zip
Phone
39S-om6�o
Contractor City of Ft. Collins SA
Tax #
Are you paying taxes her or by report?
Here ❑Report
sales tax number isrequiredbyaffmrrrctocs.
Are you paying with your trust account?
Yes ❑ No
Is this a residential or commerceflproject? Residential ❑ Commercial
If residentiali is it: MSIngIe1amily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muitfarmly (apartment) ❑ Garage
If commercial, is it: ❑ Bank EEBar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑'Retail
❑ Restaurmt. ' ❑ Other (explain)
Is this building 50 years of agemr more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permik., what year w e building constructed?
If prior to 1975, you will need amasbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preveffer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. List the compaw, name or City of Ft Collins license # }
Electrician Plumler. Mechanical Roofer Other
I hereby acknowledge that I havemad. 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 hasBeen paid and Issued.