HomeMy WebLinkAbout1753 Concord Dr - Applications/Reroof - 11/10/2011NOV/10/2011/THU 08:59 AM FAi No. P.001/001
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box S80
Fort Collins, CO 60524
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 X Roofing p 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 # 3 III 0 3 ol "A Date
For office use only
)ob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner (Name Address
Gty/State Zip
Phone CQ-Tp
M W
Colln
Hul-eql
Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
J i 5t77S li
1' r Ozf % ��
7
Contractor City of Ft. Collins sales Tax #
Are you paying taxes here or by report? X Here
D Report
SWmltax number isrequiredbya//co=« om
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or cop�mercial project? Slesidential ❑ Commercial
If residential, is it: E! Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel U Medical office ❑ Office ❑ Retail
11 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No 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 wide this application,
ption of work .F.,m-t o J
k
*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 lJ
permit is not valid until it has been paid and Issued.
, 1
Applicant: �qq
Print Name:- t L f _ f P (j iV Signature Date
3