HomeMy WebLinkAbout402 E Lake St - Applications/Reroof - 05/14/2014Planning, Development & Transportation'
Cltry}Of - 281 N. College Ave P.O. Box 580
�OI ` CO��InJS Fort Collins, C0 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 applicatio s wi not be accepted.
Application # 1 N Da3 (� Date 1
Fooffice use only.
Job Site Address (required)
Value of Constr ction (labor, materials, profit)
Property Owner NameAddress .
14ct � N1►11Qrd. yoZ GCS
City/S0 a
")t6 rti
Zip
C9 a50
Phone
97d.Z7-.3'zo
Ap licant Name / Address,
I, 7/
City/State
Zip
Phone
Contractor Address ;
c City/State
Zip
Phone
Contractor ity of Ft. Collins Sales Tax #
Sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑Yes ❑ No .
Is this a residential or commercial project? . Residential ❑ Commercial ;
If residential, is it: `Single Family Detached ❑ Condo/townhome (single family. attached) ' , ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑.Bar ❑ Church ❑ Hotei/Motel ❑ Medical office ❑ Office ❑Retail
❑ Restaurant ❑ Other(explain
Is this building 50 years of age or more? Ej Yes. ` o 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.
Description of work �5kA 9 le-5 So�4It . 50' Va"
iyl q tr W S eta rLi
*If lawn sprinkler/baclflo preventer, must list licensed plumber. Iffirst-tim A/C, must list licensed electrician.
Subcontractors: List the company name or Clty of Ft Collins license # .
Electrician Plumber Mechanical ' Roofer ' 1 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: -
Applicant: GJ
Print Name: �� ZEi�f �� Signature Date