HomeMy WebLinkAbout2808 County Fair Ln - Applications/Reroof - 08/14/201408/14/2014 08:12 3036004874
City, of
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EXCALIBUR EXTERIORS
PAGE 01/01
Planning, Development & Transportation
281 N. College Ave P.O:, Box 580
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). O Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo -voltaic
17 Ventilation ❑ Water Heater ❑ Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
comple P cab in at n o th lloation. Incomplete applications will not be accepted.
Applicat a 4� Date // q IZZ I �!
For office use only
Job Site Address (required)
Value of Construction (labor, materials, pront)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by r ort?
Here ❑ Report
Sales laxrwmberlsrryurrdayairavnnsrms.
Are you paying with your trust account?
❑ Yes O No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: EVIngle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
LJ Multifamily (apartment) ❑ Garage
If Commercial, is It: ❑ Bank 0 Bar ❑ Church E3 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 17 Yes *No Xfyes, you mayrreed to cnntactHztorlc Prerenrabon
If this is for a demolition permit, what year was th building constructed?
ifprlor to 1975, you w111 need an asbestos assassment to submit with this appl/cation.
Description of work
*If lawn sprinkler/backRow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List dre company name or a!y of R Collins license 0
Electrician Plumber MeclmnlcaL. 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 construction. I know that a
permit is not valid until it has been paid and Issued.
Applicants -P-4 < 6 J�{�
Print Name: signatu� Date