HomeMy WebLinkAbout742 Benthaven St - Applications/Reroof - 10/11/2011Fort Collins
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 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_infornletion on the application. Incomplete applications will not be accepted.
Application #
For office use only
Date 16? " %/ - ///
Job Site Address (required) Value of Construction (labor, materials, profit)
-)0-2 ,R3 )1 - _ �� $ 72/2�;P�—
Property Owner Name Address
City/State Zip Phone
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Co
Applicant Name Address
City/State Zip Phone
Contractor Lic #r-, 2 ( Z Address
City/State Zip Phone�r 7b
B Ze I"
Contractor City of Ft. Collins Sal Tax #
ere ❑ Report
Are you paying taxes here or by report? eyes
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ No
Is this a residential or mercial project? �sidentiai ❑ Commercial
If residential, is it: H-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 (expl - )
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was thLLbuilding constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
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 c struction. I know that a
permit is not valid until it has been paid andAssued.
Applicant:
Print Namef7Jk14 Signature (/ Date
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