HomeMy WebLinkAbout1966 Jamison Dr - Applications/Reroof - 08/10/2011�S City of
�,. o Coltills
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41.6-2740 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
0 Heating Unit LO Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
* Ventilation ❑ Water Heater ❑ Water Line D 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 # 9 /� �o •-- Date _ azio I:Z pjd
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
city/state ZIP
Phone
r q to i
OI
Applicant hame Address
City/state Zip
Phone
r
9
Contracto[_........._._.. Address
_. 4!tYl.S'_ ZiP---.__-.-
Phone
2� 8
Contractor City of Ft Collilis Sales Tax #
Are you paying taxes here or by report?
❑ Here XReport
Sales tax number is required by a!/ conbactors
Are you paying witli your trust account?
0 Yes 0 No
Is this a residential or commercial project? XPesidential El Commercial
Ir residentlal, Is It: ❑ Single Family Detached C] Condo/townhome (single family attached) 0 Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank El Bar El Church ❑ Hotel/Motel ❑ Medical office ❑ Office O Retail
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No If yes, you may newd to contact Historic Pra:servaticn
If this Is for a demolition permit, what year was the building constructed?
1(prior to 1975, you will need an asbestos assessment to submit m40 tins application.
Description of work
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first tIme A/C, must list licensed electridan.
Subcontractors. List the company name or GIy of Ft Collins license #
Electrician Plumber Mocha nlcal . 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 constru0on. I know that a
permit is not valid until It has been paid and Issued.
Print Name: KLi ► 1l Signature S. 1 ��''�� Date 9, q
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