HomeMy WebLinkAbout233 3rd St - Applications/Reroof - 07/31/2013City Of Planning, Development & Transportation
F6e rY 281 N. College Ave P.O. Box 580
�t Collins 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).
Complete all applicable information on the application.
Application # 1315040 a3
For ofce use only
Incomplete applications will not be accepted.
Date
lob Site Address (required) Value of Construction (labor, materials, profit)
a33 3 rJ S�ve4- 1 $ 78
Property Owner Name
Address
City/State
Zip
Phone
i
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Applicant Name
Address
City/State
Zip
Phone
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Soso
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Contractor Lic #
Address
City/State
Zip
Phone
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S-66 1?70
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ;K Here ❑ Report
Sales tax number is required by allmntractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? K Residential ❑ Commercial
If residential, is it: Q�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 50 years of age or more? ❑ Yes Il No If yes, you may need to contact Histotic Preservation
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you will need an asbestos assessment to submit with this application.
Description of work ej4 V- OS-5 L-v i !LWf c- r� S sQy �NeS
*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: '`rSignature