HomeMy WebLinkAbout5218 Mcmurry Ave - Applications/Reroof - 09/20/2011p .gym '+a
Planning,. VeveloPnv r5t & Trai':.pi3rtri d Oil
2.3I. N. College Ave P.O. Box 580
Fort Collins, C000524
Phone 970-416-2.740 Fax 2211-6134
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This appiicatio n is to be used to apply forthe fol.awincl permits only (checlt all that apply). C7 Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not eImce, change) ❑ Geis Lighter ❑ Gas Log
❑ Heating Unit El Lawn Sprinkler 0 Mobile Home replacement Roofing 0Sewer Line ❑ Photo -voltaic
❑ Ventilation El Water Heater D 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 #, _�_ _.—__ [date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Properly Owner Name Address City/State Zip Phone
Applicant Name Address ✓ City/State Zip Phone
O J
Contractor Licl Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax/ # Are you paying taxes here or by report? . ere ❑ 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?. XResldendal ❑ Commercial
If residential, is it: Single Family Detached Q Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) '"❑. Garage
If commercial, is it: El Bank El Bar El 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 contactHistoric 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
*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 #
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 cib/ ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Aaolicant: