HomeMy WebLinkAbout512 Sundown Ct - Applications/Reroof - 11/04/2011Fa'� C� {= t-
City of
Flirt COltins
Planning, D velop nt & r sportation
281 N. College Ave .0. Box 5 0
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 ARoofing ❑ 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 # V k � l Wt)
For office use only
Date it t
InZ . t
Job Site Address (required) vWSTJPJ PJA M-45 Value of Construction (labor, materials, profit)
S7M SoHDaLa
e-T �2 3
Property Owner Name Address
City/State Zip
Phone
5-12 F4i
'5oo5z
9%l443 oWS
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
D qo
ez &2ZI
-039
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
K Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes XNo
Is this a residential or commercial project? X 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 14 No If yes, you may need to contact Historic
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
Preservation
*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: /j
Print Name: FffL Signature ^1 Date o