HomeMy WebLinkAbout3944 Celtic Ln - Applications/Reroof - 09/26/2013} 1� Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
�F6rt CollinsFort Collins, CO 80524
q) 2740
®�®� Phone 9®70-416-2740 Fa®x�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 IA,Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete application.,,will be accepted.
Application # f/ Jn ii Date _/not
� ...._.._.__.
For offce use only
Job Site Address,{ required)
.Sq I Z.U�aR
Value of Construction (labor, materials, profit)
el �r
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
i SS own
City/State Zip
Phone
- 08
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sa/estax number isrequiredbya#contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: OSingle Family Detached O 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 Oft 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 K& —
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name ar 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 constnictinn_ I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: ) Signature Date