HomeMy WebLinkAbout1424 Patterson Pl - Applications/Reroof - 10/07/2011City of
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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 servlc�ange) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 11�'Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). do
Complete all applicable information on the application. Incomplete applicati ns will not be accepted. J
Application # Date
For office use only —T Z
Job Site. Address (eguired) Value of Construction (labor, materiral
l Pqf ��4 VP/ $ � - g - gS-�
Property Owner Name Address
City/State -Zip
Phone
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Applicant Name Address
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City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
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W,53 P3
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Contractor City of Ft; Collins Sales Tax #
Are you paying taxes here or by report? 4 Here
❑ Report
Sales tax number is required by au contractors.
Are you paying with your trust account? ❑ Yes
Jj' No
Is this a residential or commercial project? AV Residential ❑ Commercial
If residential, is it: a Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 9� 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
*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 city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:) j I
Print Name: rocfi�.e _ Signaturel��/ Date