HomeMy WebLinkAbout7203 Egyptian Dr - Applications/Reroof - 10/11/2011Oct 11 11 04:19p Echo RRR
303-840-0304
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Fort 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 information ontheapplication. Incomplete applications will not be accepted.
Application # ti
� 1 o �" �`-6' - Date �v i 1/1
Far office use only
lob Site Address (required)
Value of Construction (labor, materials, proftt)
Property Owner Name Address
City/State Zip
Phone C1, 75
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Applicant Name Address
City/State Zip
Phone 7 o -
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Contractor Address
City/State Zip Phone 3L>J
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
Report
Sates xnumberisr wired atractars.
Are you paying with your trust account? ❑ Yes
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Is this a residential or commercial project? Ctesidential 11Commercial
If residential, is it: A5ingle 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 ❑ OtherCexplain)
Is this building 50 years of age or more? ❑ Yes —3rNo 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.
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname 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 I egulating building construction. I know that a
permit is not valid until it has been paid
and issued.
ued. ^ 1 {\ // 1
Applicant:
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Print Name: tgnature Date
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