HomeMy WebLinkAbout831 Kingston Dr - Applications/Reroof - 11/15/2011City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
�.01rr��} ` Collins 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 ❑ 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 information on the application. Incomplete applications will not be accepted.
Application # 11 � (),44 Date
For ofce use only i n 2, si p\
to Site Address (required) Value of Construction labor, materials, profit)
I C TA )/:C T n 4 I� n $
Prop Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
Contrctor Uc #
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you.paying taxes here or by report? a<ere
❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or com ercial project? ®"Residential ❑ Commercial
If residential, is it: Tingle 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 ❑ No If yes, you may need to contact Histor/c 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 applicab'on.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, mu list licensed electrician.
Subcontractor:: 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. _ n
Applicant: Print Name-iF " - A• Signature
Date 11' -/!�_ I I