HomeMy WebLinkAbout2608 Paddington Rd - Applications/Reroof - 08/05/2014Planning, Development & Transportation
City. Of 281 N. College Ave P.O. Box 580
FOr"t Collins"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 #
D Date
For office use only
Job Site Address (required
Value of Construction (labor, materials, profit) .
Property Owner Name 0 Address
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Zip
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Phone
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A licant Name Address City/State
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Zip
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Contractor Address City/State
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Zip
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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 ❑ No
Is this a residential or commercial project? 0%F
If residential, Is it: ❑ Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
WCondo/townhome (single family attached)
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Pi 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 wlll need an asbestos assessment to submit with this application.
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If lawn sprikler/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 # N
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:
Date — , `
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