HomeMy WebLinkAbout4404 Monte Carlo Pl - Applications/Reroof - 09/12/2011Sep 12 11 07:44a Artisan Roof Repairs
970-223-9501 p.2
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8652-4
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). D Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O 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. Incomplete applications will not be accepted.
Application # �) 0 -TO 33 Date d /Z
For office use only
lob Site Address (required) Value of Construction (labor, materials, profit)
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Pr rty Owner Name ®D Address
1Y �0 City/State
Zip
Phone
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Applicant Name QTMP4N(�Address
City/State
Zip
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Contractor Lic # Address
City/State
Zip
Phone
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Contractor City -of Ft. Collins Sales Tax #
Are you paying taxes here or by report?�Here
❑ Report
Sales&vrrxirnberisrequiedbyall conbwfors
Are you paying with your trust account? ❑ Yes
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Is this a residential or commercial project? Residential ElCommercial
If residential, is it: Single Family Detaidt ed ❑ Condo/townhome (single family attached) ❑ Duplex
0 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 llistonc Preservation
If this is for a demolition permit, what year was the building constnrcted?
If prior to 1975, you will need an asbestos assessment to submit with this applicabbn.
Description of work i��c 011 i L_-' g:'La a CP..d/r5-'to=:5
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname orGtyofR co/#ns 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 wntained 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: I -
Print Name. 01:E i - '�]a ) Signature; i