HomeMy WebLinkAbout1207 Pomona St - Applications/Reroof - 05/13/2013Fort Collins
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 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). 1#11✓17%
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # g�`a5 Date ": v�
For office use only
Job Site Addres (required) Value of Construction (labor, materials, profit)
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Property ppwrier Na a
Address
City/State
Zip
Phone
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Applicant Name
Address
City/State
Zip
Phone
Contractor Lic # Address
City/State
Zip
Phone
P,- IS55
Wos�—s oo '/-
Contractor City of 6 Colfins
Sales Tax #
Are you paying taxes here or by report?
❑ Here Report
Sales tax number is required by allconbaams
Are you paying with your trust account?
Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
13�]Multlfamily (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 r�2 vinoV1i!-.
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*If lawn sprinkler/backflow preventer, must list licensed plumber. if first-time A/C; must list ensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician
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:
Print Name:`I`\\ D 0 Signature
Date S - % 2 - /