HomeMy WebLinkAbout1104 Castlerock Dr - Applications/Reroof - 03/21/2012City f Planning, Development & Transportation
FY O281 N. College Ave P.O. Box 580
�rt Collins 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 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 #r?jl a.I '-ka�S Date -2,a-
For office use only I r-,
Job Site
CLSi'e� W
Value of Construction (labor, materials, profit)
$ 1 <:A lro
Pr pert" Owner Name Address + f City/ tate
Zip
Phone
plicant Name
Address Ci /S ate
Zip
Phone
tract Lic #.
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 allcon&acmrs.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 30 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 SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preseruadon
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
C�
*If lawn sprinkler/backflow bfeventer, 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 X 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.
Applican
Print Nam.i�• I.!Ii,,�1► .. •
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