HomeMy WebLinkAbout1303 W Plum St - Applications/Reroof - 08/21/2013City of
Flirt 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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑Mobile Home replacement XRoofing ❑ 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 # " /Oldl► �i L4 Date TL2_0t-3
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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(j231j�)
Property Owner Name Addres
City/State Zip Phone
�Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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s H
Contractor City of Ft. Collins Sales Tax # �� Are you paying taxes here or by report? A, Here ���❑...///Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes y� No
Is this a residential or gommercial project? Residential ❑ Commercial
If residential, is it: 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 (expI n)
Is this building 50 years of age or more? ❑ Yes 7 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was tttt{{{e building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work (D 5�)A
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first -tip A/C, must list
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber.
Mechanical Roofer
electrician.
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: f� r`, 2A 1 D
Print Nam 6 Signat a Date