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HomeMy WebLinkAbout844 Thornhill Pl - Applications/Reroof - 08/23/2013Cit Of Planning, Development & Transportation Fy} 281 N. College Ave P.O. Box 580 OIE 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 J% 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 # -513dt 4L4q Q--, Date For office use only Sob Site Address (required) Value of Construction (labor, materials, profit) 9-Th0rrr1A1'Y i- -F- Cul1rn C7. o 1 p °= Property Owner Name Address City/State Zip Phone ct o 00l-0y07a 7h , r� h�l r0//77 ?� - Applicant Name Address City/State Zip Phone Sa is arcs Za f�9V Thor or (' Q oS C%io� - .? Contractor Lic # Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ® Here ❑ Report sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes © No Is this a residential or commercial project? ® Residential ❑ Commercial If residential, is it: Gt 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 IZ 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 will need an asbestos assessment to submit with this application. Description of work' a rr �, v ►-cav *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: 2 Print Namen iadd �nrggia>q Signature Date QRZ 3/1o&