HomeMy WebLinkAbout2508 Dallas Creek Ct - Applications/Reroof - 12/02/2011City of �� S Planning, Development & Transportation
l J 281 N. College Ave P.O. Box 580
For } ` 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 # k0412-Ykl— S�tate
For of m- use only
Job Site Address (required)
ZSmac�s
Value of Construction (labor, materials profit)
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Prty Own Name
Address
City/State
Zip Phone
Applicant a U
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Address
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City/Scat
Zip Phone
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Contractor
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Address
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Zip Phone
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Contractor City of Ft. ins Sales Tax # Are
ou paying taxes here or by report? ❑ Here J Meport
Salestarnumberisregwredbyallconba&ms. (fOB-1'f Are
you paying with your trust account? ❑ No
Is this a residential or commercial project? L4esidential ❑ Commercial
If residential, is it: Jg.Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ HotelJMotel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Flo i If yes, you may need to contact Historic Freserva0on
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"
Description of. work
1 / I
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed elecbidan. J
Subcontractors: List the company name or City of Collins license d` C o^-'
Electndan 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 aty'ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Signature
Date