HomeMy WebLinkAbout608 Stoneham Ct - Applications/Reroof - 01/19/2012City Of Planning, Development & Transportation
Fray 281 N. College Ave P.O. Box 580
�r` 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 # iJ kDate
For ofAce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
08 S At=k&nCT. $ 29U6
Property Owner Name
Address
City/State Zip
Phone
A *iAraoA
$ rlECr.
fT- 4W.!
0 3-17-0 13
Applicant Name
Address
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
q,,�, -
83 o FAT)
#102 DIF ER Co tbml
03) &Sb'o ld
Contractor City of Ft. 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? Residential ❑ Commercial
If residential, is it: bo 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 )4No 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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: 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.
Applicant:
Print Name: F,&(_ &ffl!& Signature Date I 9 Zol2