HomeMy WebLinkAbout6150 Polaris Dr - Applications/Reroof - 05/24/2013City Of Planning, Development & Transportation
Fy 281 N. College Ave P.O. Box 580
ort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY 13S• SZ.
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 ARoofing ❑ 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.
Application # 1r302!49L%
For office use only
Incomplete applications will not be accepted.
Date S 1,2A(
Job Site Address (r red Value of Construction (labor, materials, profit)
662
Property Owner Name Address
City/State Zip
Phone
t
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
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? g Residential ❑ Commercial
If residential, is it: PLSingle 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 g No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was We `building constructed?
If prior to 1975, you will need an asbestos assessment to submit w/th this application.
*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