HomeMy WebLinkAbout1307 Cape Cod Cir - Applications/Reroof - 08/08/201408/08/2014 14:36 3039352606 METRO PAGE 02/02
City of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER=THE4! OUNTER PERMITS ONLY
This application Is to be used to apply for,
❑ Demolition (interior non-structural) ❑ Elec I
ie following permits only (check all that apply). L3 Air Conditioning
cal Alteration (not service change) O Gas
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile
❑ Ventilation ❑ Water Heater ❑ Water Line
Lighter O Gas Log
toms replacement CI Roofing 17 Sewer Line ❑ Photo -voltaic
❑ Wood/Pellet Stove (must be EPA certified,
manufacturer),
provide make, model and
Complete all applicable information on the
pplication. incomplete applications will not be accepted,
Application
For alke use only
Date
Job Site Address (tequlred)
t
Value of Construction (labor, materials, profit)
yP 2 . b
ner Name Addn;
s C�i/h�'/'I'�y�C zip Phone
tApplicantme Addn-
Q�7
City/State ,Zip Phone
De►Iver a
aor
o
Addq!
bv�si✓uC'� 61 �73
; it City/State Zip Phone
C S )04; gh(Q►'I/Co Bmz (3o3�Z'ft-V44
Contractor City of Ft. Collins Sales Tax #
SHIN tax number IsregWi�dbyallconpg�rs;
Are you paying taxes here or by report? Here ❑ Report
Are you paying vvM your trust account? Yes ❑ No
Is this a residential or commercial project?
If residential, is it: ❑ Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank Q Bar 13 Church
❑ Restaurant ❑ Other,
IS this building SO years of age or more? EI Ye:
If this is for a demolition Permit, what year wa;
Ifprlor to 1975, you wlll need an asbestos assess,;
of
*If lawn sprinkler/backRow preventer, must list Iicen:
Subcontractors; List the rompany name or City ofi'
sidendal O Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
0 Hotel/Motel ❑ Medical office ❑ Office 0 Retail
(plain)
Cl No If yes, you may need to contact Historic preservation
ie building constructed?
-nt to subrrrlt IIWM thIS appl/cd-;o/
0
1 plumber. If first-time A/C, must list licensed electrician.
Collins license 0
Clecmclan— ' Plumber
Mechanical _ �^ Roofer—. Other.
I hereby acknowledge that I have read this applicatio,
cwmplY with all requirements contained herein and tit
Permit is not valid until it has been paid and iss ,
ind state that the above Information is complete and correct. I agree to
vdinances and state laws regulating building construction. I know that a
id.
Applicant. Print Name: fY o GI•l ` �� Sigma tire r
Date