HomeMy WebLinkAbout1725 Valley Forge Ave - Applications/Reroof - 06/02/2014City of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 8524
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 applic tion will not be accepted.
Application # Z 14-02CocI(- .
For office use only
11
Date 2—
Job Site Ades^s (required)�'1 Value of Construction (labor, materials, profit)
P o erty Owrier Name Address
t72s V
City/State Zip
Phone
7�2(5 �os
Applicant Name Address
Ci /State Zip
Phone
Contractor c # Address
City/State Zip
Phone
Lam'
Contractor City. of Ft. Collins S les Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
.Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: {ISingle 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 Flo � 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.
work
*If lawn sprinl6er/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Q-ty of Ft Collins license #
Electrician Plumber Mechanical Roofer 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: I % "C" Vde.4L� Print Name:? � Signature
Date ��� 1