HomeMy WebLinkAbout5055 S Lemay Ave - Applications/Reroof - 03/25/20142826
Fort Collins
Planning, Development & Transportation
281 N. -College Ave P.O. Box 580
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 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoofing O 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. Incomplete applications will not be accepted.
Application # I>14014-5B Date �J'd,Jt
For office use only
Job Site Address (required)
Value Of Construction (labor, materials, profit)a-
ki
Property Owner Name Address
City/ to Zip
B
Phone
1M.4, ,
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number isrequiredbyall contractors.
Are you paying. with your trust account?
❑Yes ❑ No
Is this a residential or commercial project? ❑ Residential Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/ ownhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar `❑ Church ❑ Hotel/Motel q Medical office ❑ Office ❑ Retail
❑ Restaurant Other (exya') _� 'pLr �1mAe
Is this building 50 years of age or mo e? ❑Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was thilding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application:
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*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or G'ty of Ft Collins license # G a S
Dedrician Plumber Mechanical Roofer M s< ther—
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: I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: b Signature Date [
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