HomeMy WebLinkAbout5303 Fossil Creek Dr - Applications/Reroof - 08/07/2014Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 on the application. Incomplete applications will not be accepted.
Application # �Date
For office use only
Sob Site Address (required) II
Value of Construction (labor, materials, profit)
I
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Or.
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Property Owner Name
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Address
9-3
City/State
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Zip Phone
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Applicant Name
Address
City/State
Zip Phone
Contractor
Address
City/State
Zip Phone
(lac,0,1 Po; A� R� �,�
5 �� , Sfi l �w�
CU 8 DSO/ 7?�60-S
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by ailcontractorx
Are you paying with your trust account? ❑Yes ®No
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? M Residential ❑ Commercial
MSingle Family Detached ❑ Condo/townhome (single family attached) ' ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building 5o 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 e r 1 `r
Z4c J C er Or �%4 9 - k<aT-C& T o XI�cqo
o�
*If lawn sprinkler/bac ow 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 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: 2 I K_] 7
Print Name:SCOi� K )fOS1,16io'l' Signature ate