HomeMy WebLinkAbout100 Kenroy Ct - Applications/Reroof - 11/12/2013Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
F! 6rt oU s Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER. -THE -COUNTER PERMITS ONLY
This application is to be useto 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 Spridsler ❑ 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 inIcanation on the application. Incomplete applications w'il not be accepted.
Application # f,3'I �vO S�ibS..DateT�
For office ase miy
job Site Address (required) Value of Construction (labor, materials, profit)
.Property Owner Name
Address
City/State Zip (�t Ss b Phone
CA r
Applicant Name
Address
City/State Zip Phone
Contractor Lit #
Address
City/State Zip Phone
-e (:10 395-046
Contractor City of Fc. Collins SEA
Tax #
Are you paying taxes here or by report? D4 Here ❑ Report
sales tax number is required by aff confoctors.
Are you paying with your trust account? Yes ❑ No
Is this a residential or cQrnmerc-s project? AiResidental ❑ Commercial
If residentiali is It: �8(SingieTarnily Detac ed ❑Condo/townhome (single family attached) ❑Duplex
❑ Mulbifamly (apartment)
If commercial, Is it: ❑ Bank 1❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑. Office ❑ Retail
❑ Resiaurmt. ' ❑ Other (explain)
Is this building 50 years of ageor more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition perzft,, what year was the building constructed?
If prior to 1975, you wl/l new awasbestos assessment to submit with this application.
Description of work
'If lawn sprinkierjbackflow pravefer, must list licensed plumber. If first-time A/C, must list licensed electriciahz. T
Subcontractors: Listthecoinpayname orGtyofFtCollins license #
Electrician Plum"iEr Mechanical Roofer Other
I hereby acknowledge that I havemad this application and state that the above information is complete and correct. I agree to
comply with all requirements contzned herein and city, ordinances and state laws regulating building construction. I know that a
permit is not valid until it Iras3een paid and issued.