HomeMy WebLinkAbout3029 Stanford Rd - Applications/Reroof - 07/24/2014 (2)City Of Planning, Development & Transportation
F01 ` Collins For N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
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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 oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stovfr (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted:
Application # '71+0+5A-& Date -7 EZy�1
For office use only
Job Site Address (required)
3 V 9fa'n;t
Value of Construction (labor, materials, profit)
7-4� -X
2 7 U-7
Property Owner Name
Address
City/Stat Zip
Phone
Conn! L cg6 a �D
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'lJo-42,(o-37
Applicant Name
Address
City/Sta Zip
Phone
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Te ICi193K
Contractor
Address
City/State Zip
Phone
S CA44fA'e_4 i
Contractor City of Ft. Collins Skes Tax #
sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ;2190
Is this a residential or co ercial project? Residential ❑ Commercial
If residential, is it: 220Single 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 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
*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: /1 nn __'' E//
Print Name: 41 JrO Signature
Date
2