HomeMy WebLinkAbout1308 W Oak St - Applications/Reroof - 03/16/2012CityOf Planning, Development & Transportation
} 281 N. College Ave P.O. Box 580
F6r` Collins Fort Collins, CO 80524
`.- Phone 970-416-2740 Fax 224-6134 v
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 # z_. (Z/C-9' Date
For`�ice use only
Job Site Address (required) . Value of Construction (labor, materials, profit)
3og o so
Ift
Property Owner Name
Ali `c� Cke'vl4 01f
Address City/State Zip
g ocd< S+ X� e, �70
Phone
7
Ap li nt Name
5� ou
Address City/State Zip
60 �5
Phone
��GSS
C ctor% Lic #
IQ,v^ 6. h 'v
Addressq City/State Zip
Phone
Contra or City of Ft. Collins Sales Tax #
Sales tax number is required by all mnbactors
Are you paying taxes here or by report? Here
Are you paying with your trust accoun . ❑ Yes
❑ Report
❑ No
Is this a residential or commercial project? 4!� Residential ❑ Commercial
If residential, is it: LM*;ingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes (25No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
.1f prior to 1975, you will need an asbestos assessment to submit with this application.
Description of %Mork 4C4� 5
❑ Duplex
❑ Retail
*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 —Elf _0 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 an to laws re lating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: C /�
Print Name: S6601 ?4e4A�Signature
Date J