HomeMy WebLinkAbout4607 Crest Rd - Applications/Reroof - 08/12/2014City of
�,�t Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524 k l tv , y Q
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 # 'f31"b 50�0�+ Date el y2�
For office use only
Job Site Address (required)
ke, 6
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
Contractor Add re s
City/State ��Zip
%
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Phone
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C ntractor City of t. Collins Sales Tax #
Sa/estax number isrequired byall contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? CKResidential ❑ 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 (expl )
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 waste nilding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of
*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 RooferLCIOther
I hereby acknowledge that I have read this application and state that the above ii
comply with all requirements contained herein and city ordinances and state laws
permit is not valid until it has been paid and issued. /?
Applicant:
Print NameJ Signature
is complete and correct. I agree to
building construction. I know that a
Date 611V1 Z /
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