HomeMy WebLinkAbout1707 Banyan Dr - Applications/Reroof - 06/12/201306-12-13;09:21AM; ;3034667385 # 3/ 3
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box $80
Fort Collins, CO 8o524
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) Cl Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit Cl 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 # f3i 3o 029 3-7
For office use only ) 0;�Gj t) /
Date r.,f/.�
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
�L / I-cct £s4q=S f'70 6.3 —.M
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
5- /17 I , d� 4v /lil�— �O �' %
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Q Here ❑ Report
Sales tax number Is required by all contracmrs Are you paying with your trust account? ❑ Yes Ix No
Is this a residential or commercial project? 90esidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) JK 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 morel ❑ Yes Ar No If yes, you may need to contactH&toricPreservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit wiM this opplicadon.
Description of work•e�r—
�3 • G �riuv ���_
*If lawn sprinkler/backflow preventer, must list licensed plumber. If Flrst-time A/C, must list licensed electrician.
Subcontractors: LIstD4ccompany name orCtyofFtCollinsdcense
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: Q 'J
Print Name: �i�r/c� /C1 %r Signature Date ��