HomeMy WebLinkAbout3921 Celtic Ln - Applications/Reroof - 07/18/2013CityOf Planning, Development & Transportation
} 281 N. College Ave P.O. Box 580
F6r` CollinsIFort. Collins, CO 80524
`,. Phone 970-416-2740 Fax 224-6134 . i"o
OVER-THE-COUNTER PERMITS ONLY q
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 se ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 21Roofing ❑ 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. Incomplete applications will not be accepted.
Application #_�� G ��`l Date
For office use only
Job Site Address (required) Valueof Construction (labor, materials, profit)
?
Property Owner Name
Address
City/State
Zip
Phone
A plicant Name
Address
City/State
Zip
Phone
Contractor Lic #
Address
City/State
Zip
Phone
i
Yp Z 2 3
7.. `(3 � .i2�
Contractor 6ity of Ft. Collins Sales Tax
#
Are you paying taxes here or by report? ❑ Here deport .
Sales tax number Is required by all contractomAre
you paying with your trust account? ❑ Yes
❑ No
Is this a residential or co mercial"project? IfResidential . ❑ Commercial
If residential, is it: ngle 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 ❑ No If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
Ifpdor to 1975, you wfll need an asbestos assessment to submit with this applicatfon.
Description of work
R
*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 #, /4
Mechanical • Roofer#
Electrician Plumber.
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: 4
Print Name: �X'fyl� T ifz i Signatu � Date
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