HomeMy WebLinkAbout5807 Pleasant Hill Ln - Applications/Reroof - 07/31/2014City of ;,,., ,F,, Planning, Development Sr Transportation
281 N. College Ave P.O. Box 58o
Fort Collins Collins,Fort - CO 8 424
Poo 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 Aloofing ❑ 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+0+?)-7 h Date — 3 I 1 LJ
For offlIce use only
- __7Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
Fr S�q Oeas� � (--L ,' l 1 Lv) _-� B 20
- 5�
ApplLican ame Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone O-10
ULY1L FTc- CO 502ZIL I
Zz-q-I Z.c0
Contractor City of Ft. Collins Sales Tax # 3 1l 0
Are you paying taxes here or by report? ❑ Here
j4 Report
Sales tax number is required by all contractors.
Are you paying with your trust account? $ Yes
❑ No
Is this a residential or commercial project? a Residential ❑ Commercial
If residential, is it: �ZSingie 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 (explain)
Is this building SO 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.
Of
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, mush list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license # Gra 2 � T' I( by%e, Q 06V n1 t
Electrician Plumber Mechanical J 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: / ' /j �; / �/
Print Name: ` -v` Signature
Date �i . ' 1H fi
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