HomeMy WebLinkAbout4000 Granite Ct - Applications/Reroof - 08/06/2014Fort 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 V*
134• S-1
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 # ' � �1'-f05Z�7 Date S& �/ 9
For office use only —
Job Site Address (required)
Value of Construction (labor, materials, profit)
41600 RJ9,4j1/-C"
Property Owner Name Address
City/State
Zip Phone
C R A iCr 4400 G gAuife
e, f 19. co///,is
ZZ5 -63r
Applicant Name Address
City/State
Zip Phone
T r� ifA�u02ESS
218 -S355
Contractor Address
City/State
Zip Phone
,oRrZ�,ve AIV& P. o.
1/53 Cjel/ tw✓
40. 90549-907-9Qo
Contractor City of R. Collins Sales Tax #
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes V No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: V 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 (explain)
Is this building 50 years of age or more? ❑ Yes 0 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 %ZCMQ(16 eX15`l o9 27 syS, S /.vg%S
A i.v A � •v e
*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 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:
Print Name: ?f /V► ✓i� l,i D►� Py S Signature
Date 8/ r, /9