HomeMy WebLinkAbout2750 Canby Way - Applications/Reroof - 10/26/2011Cit
of
F®ryt 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 (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 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 information on the application. Incomplete applications will not be accepted.
Application # Date
For office use only J\ J j ^a .
Job Site Address (required) Value of Construction (labor, materials, profit)
Z'IS0 CANC3-( FQc.o 30szs $ 31 sa
Property Owner Name Address
City/State Zip
Phone
l`96arr c./.1- (sNc« wscfa S��
c,s ", _
GI IZ`7 /8G9
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone
5-104 O'ca-3 C- Lo &aSZ`1
9 56s-"7ce3
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 0 Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
yg6 53
Is this a residential or commercial project? Residential ❑ 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 pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work (L- eJ, AQ� --3 1-. _�, O c- o . z 30 e,,
*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: �7
Print Name: (IA G4.n-2 Signature i Date