HomeMy WebLinkAbout2512 Pine Needle Ct - Applications/Reroof - 11/10/2011ro: trom: Nsmey rlct.ain ii-ii-ii ii:uoam p. .r or j
Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
FortCollins Fort Collins, 80424
�/r 0. Phone gins, COC 8052 Fax 224 6134
OVER-THE-COUNTER PERMIT. ONLY
This application is to be used to apply for the following permits only (check ail that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not se ice change) ❑ Gas Lighter ❑ Gas Log
El Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line ❑ omakOItalC el and
111 ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # �/l 1 1 �1 ✓ t
For ofce use only
lob Site Address (required)
4-5 Vi
Pro a wNam
S
Address
Sp
j Applicant Name
Address
1i.Io' ._
Value of Construction (labor, materials, profit)
City/State Zip Phone —
City/State Zip Phone
Zip Phone
Contractor Address City/State P
i J I_.1
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by reports ere ❑Report
:.
Sales tax number ;3 required %yall contractors. Are you paying with your trust account? El Yes No
Is this a residential or commercial project? L('Residential ❑ Commercial
If residential, is it: [Single Family Detached ElCondo/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 i/istoric Preservation
If this is for a demolition permit, what year was the' building constructed? ..._----
If priar to 1975, you will need an asbestos assessment to suhmit with this application.
of work
.2 : .,
*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, Rot fer�_�_.. Other.,__-_-. -
1 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. /
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Applicant:_(c:. I.(Date
Print Name:Signature-, /rr _-
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