HomeMy WebLinkAbout2200 Ouray Ct - Applications/Reroof - 06/10/2014City of Planning, Development 8c Transportation
281 N. College Ave P.O. Box 580
Forrrr+++} l 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 P<9oofing ❑ 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 # (� 14 D2. q S (e Date La - ( 0 , l
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
aa0a OQ C� CrTc 1 $ 3: 06 00
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Lic # Address City/State Zip Phone q-10
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Contractor City of Ft. Collins Sales Tax # > 3�1A Are you paying taxes here or by report? ❑ Here )d Report
Sales tax number is required by all contractors Are you paying with your trust account? )d Yes ❑ No
Is this a residential or c mmercial project? gResidential ❑ Commercial
If residential, is it: IIQSingle 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 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
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 workT.ecw gg�.0 y
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed eldctrician.
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 construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Signature
Date La- to, 11 Q
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