HomeMy WebLinkAbout3029 Indigo Cir S - Applications/Reroof - 08/18/2014CI O� Planning, Development & Transportation
®�� Collins 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 # P_'4 `( D & �?_ I (P Date
For office use only
(required)
Job Site Add7AC-4po
Value of Construction (labor, materials, profit)
L a 11
0
Property Owner Nafne Address
ity/St
Zip
Phone
1 r �i /C
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Applicant Na Address
City/State
Zip
Phone
Contractor Address
City/Stat
Zip
Phone 30)
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Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes Jp No
Is this a residential or c mmercial project? /� Residential ❑ 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 (explai )
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 was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
Description_ of work
*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: ale Signature
Date /