HomeMy WebLinkAbout4331 New Bedford Dr - Applications/Reroof - 07/30/2014City Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580
�L .7 Fort Collins, 16 80524
2740
Phone 970-416-2740 Fax 224-6134I I n n •�j
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 replacementRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stoke (must be EPA certified, provide make, model and
manufacturer).
Complete all applicabletinformmattion on the application. Incomplete applications will not be accepted.
w Application # 1 K) ► B05 Date
For office use only ,
Job SiteAddress (required) ,
Valy�E'ef construction (labor, materials, profit)
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Owner a
Address
Zip 9 �
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Applicant Name
Address
City/State Zip Phone
Contractor '
Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or cop mercial project? WResidential ❑ 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 �v.¢-ems
r' 'SAY
*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. A
Applicant:
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