HomeMy WebLinkAbout4215 Trail View Ln - Applications/Reroof - 10/24/2011City of
� Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 (c:heck all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
infomation on the application. Incomplete applications will not be accepted.
ab
Application # v \ k 0 at`51)92 to !•
For office use only �
Job Site Address (tWulrnd) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
11
Applicant Name Address City/state Zip Phone
) U3 F+ Cnllins 80521a-1
Contractor Address City/State Zip Phone
�'+ ever 802.OZ 303 Z
Contractor City of Ft. Collins Sales Tax # Are you paying tares here or by report? ❑ Here ❑ Report
Sales tax numoerisrequired bya#mnc-acwrs Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? XResiciential ❑ Commercial
If residential, Is it: ❑ Single 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 prior to 1975, you will need an asbestos assessment to suhmit with this application.
Description of work
*'If lawn sprinkler/backflow preventer, must list licensed plumbe-r. If first-time A/C, must list licensed electrician.
Subcontractors: t/st the company name or City of Ft Collins license
Electrldan Plumber riechanlcal _ Roofer
Other
I hereby acknowledge that I have read this application and stale that fhe above inf:rmation is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws rt;qulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant:
Print Name:d Rn � C Signature __ Date I t