HomeMy WebLinkAbout3000 Placer Ct - Applications/Reroof - 11/01/2011City of Planning, Development & Transportation
F` ,_t CollinsFor N. College Ave P.O. Box 580
r�U(' V ` 1' 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
w�� on the application. Incomplete applications will
/not be accepted.
Application # 8 z% D 2 / Date ! /✓ L/Z
�ifice us —
Job Site Address (required)
-p Value of Construction (labor, materials, profit)
3000 PI-6-6ER CT
`=T- CULL/NS , Go soSoJr,
Property Owner Name
Address City/State Zip Phone
L_C=o A)A_K () L
Q00 PLAGEr> c FT, GOL,I-/N 05-dG q7o-,R -86
Applicant Name
Pao Fe SS toAl ►i-`
Address City/State Zip Phone
'7qd o a 3- -
Contractor
Address City/State Zip Phone
PF,oFGSs/oN,11-L Rop irvro 57g0,s7-- /4k0417,4- 900a VS - o2-0-0ff
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report? 'N Here ❑ Report
Sales number is required by all contractors:
- 2 n-7 q
Are you paying with your trust account? ❑ Yes A No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: RQ 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 XNo 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 submit with this application.
Description of work _ I-E Pr b F F R.00 F 4- R F' - R 0 O F
*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. -
Print Name:6l 01 2 / / l Signature Date
v r 7 -��
W