HomeMy WebLinkAbout1937 Angelo Dr - Applications/Reroof - 10/10/2011Planning, Development & Transportation
City Of 281 N._College,,Ave +P:O Box 580 �
Fort Collins Fort Collins, CO 80524'' a 2'. ' _,
Phone970-416-2740 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) O.Gas Lighter p Gas Log
❑ Heating Unit ❑ Lawn Sprinkler.0 Mobile Home replacement Roofing ❑ Sew'er.Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ _Water Line, _-❑ Wood/Pellet Stove (must:be EPA certified, provide make, model and
manufacturer).
Complete alLapplicable information`on the application. incomplete applications:will not be accepted.
Applicatiom#N0�5i0�` Date;
For oliice use only 'i,
Job Site Address (required) <
Valueof Construction (labor, materials, profit)
P tO
Address
City/State Zip Phone
A cant Name Address City/State Zip Phone
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Contractojj /1 Lic #
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Address
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City(State Zip Phone
Contractor City of R. Collins Sales Tax #
Safes tax number is required by all contractors
Are you paying taxes here or by report? KHere ❑ ,Report
Are you paying with your trust account? ❑ Yes XNo
Is this a residential or commercial project? DkResidentlal ❑ Commercial
If residential, is it: ❑ Single Family Detached 0 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 ❑ No If yes, you may need to contact Historic Preservadon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wf/f need an asbestos assessment to submit with this application:
Description of work
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of H Collins license #
Electrician Plumber Mechanical Roofer V,_ 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..
Applican .
Print Name: I Signature ate