HomeMy WebLinkAbout1227 Truxtun Dr - Applications/Reroof - 10/10/2011OCT/10/2011/MON 01:39 PM FAX No, P.004
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City of Planning, Development & Transportation
Fort Collins
N. College Ave P.O. Box 580
! For
Fort L Fart 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). O Air Conditioning
❑ Demolition (interior non-structural) CI Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement X 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— I (� - I (D— 2-011 -1. Ub
For office uSe only —
Job Site Address (require
Value of Construction (labor, materials, profit)
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Property Owner Name :.
Address
City/State
Zip
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Applicant Name
Address `.
City/state
Zip
Phone
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Contractor /
Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? )K Here ❑ Report
sal tarnumber/s vquzred bya/l eonbaaas Are you paying with your trust account? ❑ yes ❑ No
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Is this a residential or commercial project? C'Residential ❑ Commercial
If residential, is it: EiSingle Family Detached 17 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 11 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office CJ Office Q Retail
0 Restaurant ❑ Other (explain
Is this building 50 years of age or more? ❑ Yes IrNo If yes, you mayneeu-to Contact HistonCPreservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need:an asbestos assessment to submit with this application.
of work
*if lawn sprinkler/backnow 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 Mechanlcal
Roofer ",&SP � 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:
Print Name: kj { Vt1j Signature_
Date