HomeMy WebLinkAbout508 W Trilby Rd - Applications/Reroof - 02/28/2012City Of Planning, Development & TransportatioF6rtn
N. College Ave P.O. Box 580
CollinsiI IFort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY �7
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.
Zms Application #� �� � O Date -2 P1
For office use only
Job Site Address (required) So /4 Value of Construction (labor, materials, profit)
57 5 ,
Property Owner Name Address
City/State Zip
Phone
08
. T1 IRY AN FaLr Col 6%)S 2OS'L S
Z2(a - y90
Applicant Name Address
City/State Zip
Phone
Contractor Lic, # Address
City/State N( Zip
Phone
N 4( 1_1 0S44
q - 2-190 Co
Contractor City of Ft. Jecillins Sales Tax #
Are you paying taxes here or by report? 2'Here
❑ Report
Sales tax number isrequired byall contractors.
Are you paying with your trust account? ❑ Yes
JD -No
Is this a residential or commercial project? .Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) L-iDuplex
❑ 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 .rNo 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: ��`�� \ Q�
Print Name �1 LA.c� f 3A.V AJI F Signature r �J o J� Date 2 2g i L