HomeMy WebLinkAbout906 Bramblebush St - Applications/Reroof - 05/12/2014Belmarez 970-667-6731 p.2
Clt Of Planning, Development &Transportation
FFortI 281 N. C911ege Ave P.O. Box 58D
ort Colons Fort Collins, CO 80524
Phone 970-416-2740 Fax 22a-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (Fheck all that apply). O Air Concition.:n;
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler Cl Mobile Home replacement ❑ Roofing ❑ Sewer Lire ❑ Piotc•voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal
manuiacturer)•
Complete all applicable
e� information on the application. Incomplete applications will not be accepted.
Application # 5114� V C 31- l Date 1 � l r� l c�� ! _
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit.,
Property Owner Name
Applicant
Contractor
Address
Address
t N1
Lic # Address
zip Phone Zip Phone
Zip Phone
t I t r ?I A
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Here epo-
salesr2xnumber ismquuedbyail con&== Are you paying with your trust account? ❑ Yes vo
Is this a residential r commercial project? O8esidential ❑ Commercial
If residential, is It: ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0Multifamily (apartment) ❑ Garage
If commercial, is it:. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Reta:l
❑ Restaurant ❑ Other (ex �lain)1_
Is this building 50 years of age or more? O Yes �,Y� !(yes, yov may beed to contact Historic Preservation
If this is for a demolition permit, what yearwas the building constructed? I
1f prior to 1975, you will need an asbestos assessment to subm/t with this ap,&icadon.
Description of
*If fawn sprinkler/backflow preventer, must list licensed plumber. It first-time A/C, must list licensed electrician.
Su bco ntractors: List the company name or City of fP Collins license 0
Sectrician Plumber 1 Mechanical Roofer Other
i I
1 hereby acknowledge that I have read this application and state that the above i
comply with all requirements contained herein aril city ordinances and state laws
permit is not valid until it has been paid and issued.
i
is complete and correct. I agree cc
building construction. I know that a
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