HomeMy WebLinkAbout1801 S College Ave - Applications/Reroof - 02/24/2012Planning, Development &•Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
T is 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.
Application # 8/�- 60 r
For o ice use only
Incomplete applications will not be accepted.ra�
Date ic'3. 52t! a. o l Z
Job Site Address (required) Value of Construction (labor, m ter' Is, profit)
D ! 6-a . if $ d
Property Owner Name Address
City/State Zip
Phone
DOVE Qr 6u.,#45 60 8052T
9 b - 226 .
A licant Name Address
City/State Zip
Phone
/`,- xi #ala vap 00o011PA
OR Ak-r tpwos to oTa7 q70-do14-01 D
Contractor Lic # Address
Ci State zip
Phone
,ffl 759 19411 X,06012WWTWa
- 411
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax num erisrequired byall contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential 13 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 U Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )VNo If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 1910
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
-f k' ;r -
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractor:: List the company name or City of Ft Col/ins license #
Electrician Plumber Mechanical Roofer
Other
X,
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. C
Applicant: C ��✓ S�
Print Name: ��'� Signature Date OZ -2—