HomeMy WebLinkAbout619 Powderhorn Dr - Applications/Reroof - 09/19/2011City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F®r } ` Collins 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 ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ 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 #�Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/Scat Zip
Phone
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Contractor
Address
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Phone
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Contractor City of Ft. ins Sales Tax # Are
ou paying taxes here or by report?
❑ Here j Meport
Sales tax numbarksrequiredbyall canbactors. Are you paying with your trust account?
P'yes ❑ No
Is this a residential or commercial project? [Residential ❑ Commercial
If residential, is it: 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 S"0 i if yes, you may need to contact Historic Preser abon
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you wil/ need an asbestos assessment 69 submit with this applicat'on.
Description of. work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. /dn►.`rw
Subcontractors: List the company name or City of Ft Collins license # C o rN,
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. '00e n
Applicant: Print Name: l{�^ / 9��j,
M l UUrL� S Signatu Date %'