HomeMy WebLinkAbout5412 Fossil Ct N - Applications/Reroof - 08/14/2014Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CC 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 on the application. Incomplete applications will Inot be accepted.
Application # F144c Uo7q) Date
For afte use only
Job Site Address (&Vulre+dr)
Value of Construction (labor, materials, proflo) q0
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins SaIA Tax #
Are you pa911149 taxes here or by report? ere ❑ Report
ales tax number Isrequdedbyall contracwm
s
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Wesidential ❑ Commercial
If residential, is it: &blngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail C9 Sit
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to ct7ntact H/slnni Preservation
If this is for a demolition permit, what year was the building constructed?
ifpuhr to 1975, you will need an asbestos assessment to submit with this applkabbrn.
work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the compiany name or 02y of R CONIns lftn$8 0
Electrician plumber Mechanical Roofe 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: =E41 10�7 Signature
Date
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P41