HomeMy WebLinkAbout3512 Kent Way - Applications/Reroof - 03/31/2014--;ci`d IOTA
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Coillns,:CO 80524
Phone 970-416-2740 Fax,224-6134
OVER-THE-COUNTER" PERMITS ITS 0�VL�
This application is.ta be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation n Water Heater ❑ Water Line Q WocdlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.,
Application/ �f 0 / Date . 3"31
For oice use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
OL City/State .�� Zip FLPhone
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Applicant Name Address
City/State Zip
Phone q-7a_-
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Contractor Address
ity/State Zip
Phone
Contractor City of Ft. Collins Sales Tax a
Are you paying taxes here or by report? ire
with trust account? es
❑ Report
❑ NO
saiesbxnumberisraquiredbyalicantracmrs
Are .you paying your
is this a residential or commercial project? Residential ❑ Commercial
If residential, is It: (9 Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
[7 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑Restaurant 0 Other:(explain)
Is this building'SO years of age or more? ❑ yes ❑ No Ifyes, you may need to:conlactHisfaricPreservatlon
If this is for a demoidtion permit, what year was thd-building constructed? IicaDon.
If prior to 1975, you wi/l need an asbestos assessment to submit with this app
Of
Yi
"If lawn sprinkler/6ackr�owpreventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: Ustthe companyname orcity ofFtCollins license
decbi ian�— Plumber
Mechan101 - Roofer R- lBSq other . _.
I hereby actaiowiedge 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.
y„L LN -J e-titvl i YtiG} S Signature-.-
�i Date