HomeMy WebLinkAbout2806 W Lake St - Applications/Reroof - 10/12/2011Cityof Planning, Development & Transportation
C 281 N. College Ave P.O. Box 580
Ort f Collins Fort 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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacementXRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableinfo a onnon the application. Incomplete applications will not be accepted.
Application # 1?5 Ito VLI Date (y- ez -
For office use only f A (
Job Site Address (required) Value of Co struction (labor, materials, profit)
02� U-) bd)- W 27�d
Property Owner Address
City/State
Zip
Phone
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Applicant Name Address
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City/State
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Zip
Phone
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Contr or Lic # Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
saiestax number isrequiredbyall contractors.
Are you paying taxes here or by report?
Are you paying with your trust account?
Aere ❑ Report
❑ Yes ❑ No
Is this a residential or commercial project? A'Residential ❑ commercial
If residential, is it: AAningie 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: &Ir
-Print Name:(���2�L�
Date /Ol'1/1
5K-57
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