HomeMy WebLinkAbout2406 Ute Ct - Applications/Reroof - 10/31/2011to: rrum: eaiucy nLLaiu a-ur-ar ,: uJnni N. J u. o
Flirt othns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 k 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 informations on the application. Incomplete applications will not be accepted,
Application # 1 �1 0 I `0 Date I Q•31. 1 I �O Dai
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
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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? 'Here
❑ Report
Salestaxnumberisrequiredbyaiicon"dory.
Are you paying with your trust account? ❑ Yes
No
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Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 'R'No If yes, you may need to contact tlistoric 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.
of work
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*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 #
Mechanical Roofer R • .
Electrician
Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. 1 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, A'' �nr��
Print Name: Q5tu W � Y�n Signature X4 Date )
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