HomeMy WebLinkAbout2100 Connecticut Dr - Applications/Reroof - 10/25/2011OCT/25/2011/TUE 11:02 AM PAX No. P,005
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Fort Collins
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 58o
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) Ci Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement )0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Cl 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 # 6110c (i n/� Date i c — 225 "-2�ol) 77-LR, --
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? A Here
0 Report
S2/es taynumberisrequord by all wMmdas
077L
Are you paying with your trust account? ❑ Yes
Cl No
Is this a residential or commercial project? CS-6sidential ❑ Commercial
If residential, is it: mangle 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 Ifyes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
Ifpricr to 1-075, you wil/need an asbestos assessment to submit with this application.
of work
`If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors. List the company name or Gty of Ft Collins license g
Electrician Plumber Mechanical Roofer; IaSPEZ 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. ` n
PrinC Name: LC�>r Q U t° �t; Signature ��; Date 10 - 2_4 ✓—L-UI'