HomeMy WebLinkAbout1204 Emigh St - Applications/Reroof - 01/03/2014Clt Of Planning, Development tic Transportation
Fort Collins Fort N. College Ave P.O. Box 580
t 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 ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # 31`{000160w
For office use only
Incomplete applications will not
be accepted.
Date "
lob Site Address (required) Value of Constructio�abor, materials, profit)
A20 y �� . $ 2.s�
Property Owner e Address
City/State Zip
Phone
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Applicpnt Name Address
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City/State Zip
Phone
�ntractor�Lic # Address
City/State Zip
Phone
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
Miere ❑ Report
Sales lax numbgr is required by all contactors
Are you paying with your trust account?
t
❑ Yes ❑ No
Is this a residential or commercial project? 01�iidential ❑ Commercial
If residential, is it: mangle Family Detached ❑ Cohdo/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 SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
work
*If lawn sprinkler/baclfflow 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 b ' ing construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: RAF 0 F/J
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