HomeMy WebLinkAbout1305 Teakwood Dr - Applications/Reroof - 10/10/2011City OF Planning, Development & Transportation
281 N. College Ave P.O. Box 580
For`} Collins Fort Collins, CO80524
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 se ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ioofing ❑ Sewer Line ❑ Photo -voltaic
El Ventilation ❑ Water Heater El Water Line ❑ Wood/Pellet St,`,7(e (`must be EPA certified, provide make, model and
manufacturer).
Complete all applicable n 1 rp� F on application.
Application # 11 V
For office use only 1'7 G
Incomplete application11C)
will n��tbe accepted.
Date I u
n r.
Sob Site Add (i fired) Value of Construction (labor, materials, profit)
P pe Owner Name Address
City/S to Zip
r
�a
Phone
pli t Name Address
City/State Zip
Phone
L
ntractor Lic Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Ta #
Are you paying taxes here or by report?
ere
❑ Report
Salesraxnumberisrepuiredbyalimntra
Are you paying with your trust account
es
❑ No
Is this a residential or commercial project? esidential ❑ Commercial
If residential, is it: ngle Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
c(«c ❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex ")
Is this building 50 years of age or more? ❑ YesNo If yes, you may need to contact Nisfonc Preservation
Ebt
If this is for a demolition permit, what year was ildingconstructed?
if prior to 1975, you MY need an asbestos assessment to submit with this application.
escrip 'on of work
*If lawh sprinkler/backflow preven , must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or City of Ft Co//ins 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 Na %i SignatureDate