HomeMy WebLinkAbout1015 Elgin Ct - Applications/Reroof - 07/23/2013City Of Planning, Development & Transportation
i a , 281 N. College Ave P.O. Box 580
�01f� 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. Incomplete applications will not be accepted.
Application #
For ofte use only
Date
Sob Site Address (required) Value of Construction (labor, materials, profit)
1015,- eto, lK Ck $ `c -—s—bC, K'-
Property OwnerName Address
City/State
Zip
Phone
-jvl ; � rn-2 t o (�- e I t v\
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C4 6- . C
Fb 52�(
Applicant Names Address City/State
69gLf 1e03vwea,I C�• �� • c-
Zip
Phone
6&0 YY 7
Contractor Lic # Address
City/State
Zip
Phone
Vt-2111
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here
or by report?
❑ Here ❑ Report
saiestaxnumber isrequired byall contracto
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? $Residential ❑ Commercial
If residential, is it:-ETSingle 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 ❑ 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 wfll need an asbestos assessment to submit with this applfcatfon.
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*If lawn sprinkler/baclflow 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 #
Bectrician 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: W l LKRf/t^aSig
nature Date