HomeMy WebLinkAbout2542 W Laurel St - Applications/Reroof - 10/12/2011City Of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 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 sere a change) ❑ Gas Lighter ❑ Gas Log
n ❑ Heating Unit ❑ LawSprinkler ❑ Mobile Home replacement�oofing ❑ 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
tion on the application. Incomplete applications will notbeaccepted.
Application # � � I t&9001A Date
For office use only I A ri 5;1)
Job Site Address (required) Value of Construction (labor, materials, profit)
2Z, $ 17D d
Property Owner N me
Address City/Stat Zip Phone
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Applicant Name
AddressG City/State /} Zip Phone
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Contractor Lic #
Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? XHere ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commgrcW project? }21cesiclential ❑ Commercial
If residential, is it: Ingle 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow 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 construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: `
Print Name:
Date ��/y ///
57
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