HomeMy WebLinkAbout4020 Torridon Ln - Applications/Reroof - 09/17/201309/12/2013 15:36 3034775557
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Planning, Development & Transportation
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 13 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.
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Application # TJ (� C 'i �1 Date "I' — - — a0l3
For oA9ce use only
Job Site Address (required)
Values of Construction/((labor, materials, profit)
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Ap licant Name Address
City/State Zip Phone
Contractor Address
Gty/State Zip Phone
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?, were ❑ Report
Sales tax nu� b ufiW byaUwntractors
Are you paying with your trust account? ❑Yes XNo
Is this a residential or mmercial project? Residential ❑ Commerdal
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(ex lain)
Is this building 50 years of age or more? d Yes ,RNo If yes, you may need to contact Historic Preservation
If thiy M for a demolition cermit, wbM wPgva�s tl, .I.NAh�, ...— I;..r-Ir;-
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Descripticip of wGr CVO)
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City 7 tCo/Iins/ke7SEA+
Electridan Plumber M nlCal 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. 1 know that a
pprmit k -nr* v9lid untirit has basin F-aed and lcauadr
AppliranUr —
Print Name: Signature Date
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