HomeMy WebLinkAbout806 Bitterbrush Ln - Applications/Reroof - 06/23/2014City Of Planning, Development & Transportation
i 281 N. College Ave P.O. Box 580
F6rt 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 Aooflng ❑ 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 # e) jt-�-C7' -�Joqo�( Date (P q
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Uc # Address
City/State Zip
Phone C}-10
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Contractor City of Ft. Collins Sales Tax # u 1-tn(_p
Are you paying taxes here or by report? ❑ Here
X Report
Sales tax number is required by allcontniciors.
Are you paying with your trust account? $ Yes
❑ No
Is this a residential or commercial project? I1 Residential ❑ Commercial
If residential, is it: 1f5ingie 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 []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.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed el ctrician.
Subcontractors: List the company name or City of Ft Collins license #
Electridan Plumber Mechanical Roofer Other,
I hereby acknowledge that I have read this application and state that the above information is complete and coned 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: Signature
Date 6 --A - q
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