HomeMy WebLinkAbout5627 Condor Dr - Applications/Reroof - 08/08/2014Planning, Development & Transportation
City/ Of 281 N. College Ave P.O. Box 580
F��"'t 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 ontheapplication. Incomplete applications will not be accepted.
Application # � I`� �`r Date
For office use only �`_;2 v
Job Site Address (required)
X-oo\', Rr2fnL6
Value of Construction (labor, materials, profit)
10), 'S I
Property Owner Name Address
City/S to
Zip
Phone
Applicant Name Address
City/State
Zip
Phone
Contractor Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax numberisrequiredbyall contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? A 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 ❑ 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
C.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
iiSubcontractors: List the company name or City of Ft Collins license #
Electrician Plumber.
Mechanical RooferkJ_ 4 ther
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. r_1
Applicant: 7�6
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Print Name: " signature