HomeMy WebLinkAbout5215 Country Squire Way - Applications/Reroof - 07/31/2014Planning, Development & Transportation
city Of 281 N. College Ave P.O. Box 580
Fort 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 se ce 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.
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Application # �N '1 u nk
For office use only
Date '1- 3 L I `'
Job Site Address (required)
Value of Construction (labor, materials, profit)
5-�) 15
(o 1I: �S to Mai 2-g
Property Owner Name Address
City/State Zip
Phone
Cb 1 te,J 5-.) (0��
464( 1/'ns (0"90-T
a/70-,; -9.2aa
Applicant Name Address
City/State Zip
Phone
. ror Ifir`S (0 NfEaS
- 91- Ise
Contractor Address
City/State Zip
Phone
)or-� 1G�rt Co AD.�-1s
�3' 9io-p$$`�
Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or co mercial project? �LkR
If residential, is it: Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes A 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 willneed an asbestos assessment to submit with this application.
Description of work �-
*If lawn sprinkler/backfiow 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 # _
Mechanical Roofer �X
Electrician Plumber,
R) 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:
Date / - 3 1— 1