HomeMy WebLinkAbout2760 Coal Bank Dr - Applications/Reroof - 09/20/2011Planning, rieVe10P?-0--79 faZr�i35�leJo'ts?iaui?
N. College ,4ve P.O. Box 53
Fort Collins, CO 8052-1 l
Phone 970-4l'-?.1'I0 fax 2>'! 57.:'.
OWN
This aplJiir ation is to be used to apply far the
permit,- only (chi:Gk all ti?at apply). t.1 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service- change) ❑ Geis Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler f_l Mobile Home replacement *Roofing ❑ Sewer Line ❑ Photo -voltaic
I_] Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
rnanufacturer).
Complete all applicabl rf r tion on_ he application. Incomplete applications will not be accepted. ----
Application #F _ ' 1_ _ �---- nVte--- q L For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
r7 7 7
Applicant.Name Address City/State Zip Phone
c
Contractor /
Lic #-)-1�I 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 is required by all contractors. Are you paying with your trust account? ❑Yes ❑ No
Is this a residential or commercial project?. KJ Residential 0 Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) °`❑ Garage
If commercial, is it: ❑ Bank ❑ Bar : C] Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Restaurant ❑ Other (explain)
Is this building 50 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 prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work _ I t '
ri-
501
*If lawn sprinkler/backflow 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 #
Plumber Mechanical_ --Roofer Other.
Electrician
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.
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