HomeMy WebLinkAbout851 Thornhill Pl - Applications/Reroof - 07/24/2013City of
ro ri Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 eryice 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. Incomplete applications will not be accepted.
Application # —3 1 3o 3-7ao Date 1—c) Lt " ) 3
For office use only
Job Site Address (required)
•
Value of Construction (labor, materials—n Qf{t) n
9 f O
an I `Itc
(y�`'(
perty Owner Name
Address
City/State Zip Phone
Applicant Name
Address
City/State Zip Phone
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Contractor
Address
City/State Zip Phone
Lo
Contractor City of Ft. Collins Sales Tax #
Are youTdying taxes here or by reportX�>kHere ❑ Report
sales tax 1! �aarontractors.
Are you paying with your trust account? ❑ Yes vXNo
Is this a residential or commercial project? (Residential ❑ Commercial
If residential, is it: ❑Single Family Detached` ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Hank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes KNo If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of
Subcontractors: List the company
Electrician Plumber
must list licensed plumber. If fur.L- rile A/c, must list licensed
lame o Collins license #
Roofer _ Other
I hereby acknowledge that I have read this application and state that the above inibunation 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
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