HomeMy WebLinkAbout130 W Skyway Dr - Applications/Reroof - 11/10/2011Fort 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 servee 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 informationonthe application. Incomplete applications will not be accepted.
Application # � a Date �0 1
For ottic use only
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Job Site Address (required) Value of Construction (labor, materials, profit)
(3c> SiLU (_�) 'Z�'/ F� �c�(%;/�S CC> 1 $
Prope Owner me Address
City/State
Zip Phone
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Applicant Name Address
City/State
Zip Phone
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Contractor Lic # Address
City/State
Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequired byall contractors .
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or�co%Rmercial project? RrResidential ❑ 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 (explai
Is this building 50 years of age or more? ❑ Yes DKo If yes, you may need to nt 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 iylt , this application.
Description of work
*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 r lating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: u c� d'.
l c o /t � \ l ( (� �
Print Name: Signature Date