HomeMy WebLinkAbout817 Prescott St - Applications/Reroof - 11/18/2011Clt of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins,
CO 80524
Phone 970-41616-27402740 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 (notkepyiee change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement in ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet ove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications/will not be accepted.
Application # N \ oqo_ri�) Date
For office use only F-N
Job Site Address (requireq2 Value of Construction (labor, materials, profit)
e/7 Pr esco� . $ a6 aw�
Property Owner Name
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Address City/State
�I� esa� �St- �->< Callrns
Zip
(3)5
Phone
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Applicant Name
Address City/State
Zip
Phone
Contractor Lic #
Address City/State
Zip
Phone
' n
Contractor City of t. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
sales tax number is required by all contractors. Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? �Mesidential ❑ 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 (explain)
Is this building 50 years of age or more? ❑ Yes '�5'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 with this application.
of work
�7
*If lawn sprinkler/backnow preventer, must list licensed plumber. If eirst-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer' \ I 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.
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Applicant:
Print Name: Signature26-%IDate 1