HomeMy WebLinkAbout7527 Triangle Dr - Applications/Reroof - 10/20/2011Planning, Development & Transportation
Lei Of 281 N_ College Ave P.O. Box 580
&t Cotti.nS... 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 LQ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 'Cl Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line O 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 # (b \ �y 9,�)D Date
For office Use only
H
JobSite Address (required)
Value of Construction (labor, materials, profit)
5-Zl _16
& Co ' U 0r 2S RI O 41 Z - MZ-
Property Owner Name dress
City/State Zip Phone
I. yI 9r 50 W. 120
L 4 205 hy0Lm did Cz� C3tz� �3�f
Applicant Name Address
City/State Zip Phone
Contr r Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
Sales tax number sn?4ultedbyallconbactars
Are you paying with your trust account? ❑ Yes t�N0
Is this a residential or commercial project? eResldential ❑ Commercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaip)
Is this building 5o years of age or more? ❑ Yes 8 No If yes, you may need to contact 11istoricPreseruation
If this is for a demolition permit, what year was the building constructed?
If pr/or to 1975, you w/ll 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: Ust the company name or CO of Ft Collins license #
Mechanical Roofer Other
Electrician Plumber
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: 1{+�IO �1
Print Name:�f I � i/ 5lgnature Date