HomeMy WebLinkAbout1325 Leawood St - Applications/Reroof - 08/13/2014Ciof
F®r t CoWns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax.224-6134 417 3 ,Z
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 # 131"1b9(S Date I :�Is I
For office use only
Job Site Address (equire
Value of Construction (labor, materials, profit)
Pr perry Owner Name
p
Address
City/State
Zip
Phone
Applicant Name
Address
City/State
Zip
Phone
Contractor
Address
City/State
Zip
Phone
r
r�"
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors.
Are you paying with your trust account?
�_/
❑ Yes �J No
Is this a residential oMultifamily
mercial project? Residential ❑ Commercial
If residential, is it: ngle Family Detached ❑ Condo/townhome (single family attached) El Duplex
(apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant El Other
(explai )
f?J No If yes, you may need to contact Historic Preservation
Is this building 50 years of age or more? 0 Ye� &If this is for a demolition permit, what year was th uilding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn onkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber.
Mechanical Roofer
n.
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 - lie Q Signature
Date