HomeMy WebLinkAbout3144 Yellowstone Cir - Applications/Reroof - 07/23/2014 (2)City of Planning, Development & Transportation
t ^ `Ott' ns For Fort N. College Ave P.O. Box 580
F
,r1;��``'+1r1—' Collins, CO 80524
Phone 970-416-2740 Fax224-6134
OVER-THE-COUNTER PERMITS ONLY $ I Z3' 23
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 A 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 H f6j L+0LA Z101 Date I- 2 3 -1 `-1
For office use only
Job Site Address (required)
Value of Cop�truction (labor, materiall�s,, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
Ciity_//State� Zip
Phone
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Contractor Address
CCi't'y/Stat Zip
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Contractor City of FL Collins Sales Tax fl
Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number is requ/red by all contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 9 Residential ❑ 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 (explain)
Is this building 50 years of age or more? ❑ Yes CY No if yes, you ma, lgeed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? 1.�
if prior to 1975, you will need an asbestos assessment to submit with this application .
Description of work
* If lawn sprinkler/backflow preventer, mu st list licensed plumber. If first-time AIC, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins License y
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 t o
comply with all requirements contained herein and city ordi nances and state laws regulating building construction. I know that a
permit Is not valid until It has been paid and Issued.
Applicant:
Print Name: �/ Signa Date