HomeMy WebLinkAbout818 Butte Pass Dr - Applications/Reroof - 08/19/2014To: City of Fort Collins Page 2 of 2 2014-08-19 21:40:45 (GMT) From: KUDZU Companies
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Planning, Development 8r Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61340
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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 IgRoofing. ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be:EPA certified, provide make, model and
manufacturer).
Complete all applicable informtatiionn on the application. Incomplete applications will not be accepted.
Application # I L+ 6p�.1c�0 Date' i
For olflce use wily
Sob Site Address (required)
Value of Construction (labor, materials, profit) q70
Property Owner Name Address
City/State Zip
Phone
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5M%'--e. As irk*
Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or by report?
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KHere ❑ Report
Safer ta...n," .: ,;., !s _ tilreil by aD contactors.
Are you paying with your trust account?
❑Yes ❑ No
Is%this a residential 'or mmereial:project? Residential ❑;Comrnerciai
If residential, is it: Single Family Detached ❑ Condo/townhorn6 (single fatuity atta66d): ❑ Dupl2x'
❑ 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? Cl Yes A Vo If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the'triMcling constructed?
If prior to 1975, you will need an asbestos assessment to submit with this aPP licatron.
SCI hptl0ii. of WOFIC : t�s * `
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must Bst licensed electrician.
Subcontractors: Ust the company name or ..04y of f? Co1#n:s 11rense #
Elettrfclan ___ Plumber_1K�:. Mechanii:al Roofer u Other.
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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 R has been paid and Issued.
Applieartt. ...,
Print Iwime: ignature % Date