HomeMy WebLinkAbout900 Butte Pass Dr - Applications/Reroof - 08/20/2014City Of ,Planning; Development & Transportation
281 N. College Ave 'P.O. Box 580
Flirt Coders Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 i tice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replaces I 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 #_ 1�I4W47el Date
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
*V oaas
1&-7
Property Owner Name Address
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City/State Zip Phone
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Applicant Na/�e Address City/State Zip Phone
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Contractor ;F± Address
City/State' Zip 'Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all conbaLtom
Are you paying with, your trust account? es ❑ No
Is this a residential or cS mercial project? residential ❑ Commercial
If residential, is it: JI Single Family Detached ❑ Condo/townhome(single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel .❑ Medical office ❑ Office ❑ Retail
13 Restaurant ❑ Other (explain)
Is this building 50 years of age or.more? ❑ Yes ❑ No If yes, you mayneed to contacthisiOnCPreservation
If this is for a demolition permit, what year was the building constructed?
IfPnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backHow 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 wnstructlon. I know that a
permit is not valid until it has been paid and issued.,
Applicant: /)/
Print NameSU le A" r.`�,/Y+z C��Y;%r Signature ���f��/t i is �/��, Date
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