HomeMy WebLinkAbout4014 Berwick Ln - Applications/Reroof - 07/18/2013Cit����/ Of I (D, T� 281 N!Coll ge Ave, Development
P.O. Box 580sportation
F6rrr1}� 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.
Application # i3l 303(al o`�+
For office use only
Incomplete applications will not be accepted.
Date 711Y// $
Sob Site Address (required), Value of Construction (labor, materials, profit)
S1U6v u� tG lc� 1tl $ 'R'" &v�
Property Owner Name - Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Lu
Contracto Lic # Address
City/State
Zip
Phone
Arvywr VwDfincA R- 2,509
C A 63 _ q 1n.0
Contractor City of R. CdIfins Sales Tax #
Are you paying taxes here or by report?
allere d Report
sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? if Residential ❑ Commercial
If residential, is it: -0 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 SO years of age or more? ❑ Yes K 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 wlll need an asbestos assessment to submit with this application.
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or c/ty of Ft Collins license #
Electridan 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: /t�
Print Name: t'J V1 �i is Signature
Date -7/z c h 3