HomeMy WebLinkAbout1937 Unity Ct - Applications/Reroof - 03/20/2012City of Planning, Development &Transportation
281 N. College Ave P.O. Box 580
F6r } 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 ❑ 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 # `Zb1? u1 Dade
For office use only LNv' 0
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State
Zip
Phone
Applicant-iVame Address
City/State
Zip
Phone
NFontractor
Li ,# r/� � Address
City/State
Zip
Phone
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Contractor City of Ft. Collin' ales Tax #
Are you paying taxes here or by report?
❑ Here Report
Sales tax number is required by all wnb-actois
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or.commercial project? `Residential ❑ Commercial
If residential, Is it: fl�`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 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?
Ifpeor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backRow 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 #
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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.
A licant:
Print Name:'/�.L���/�t S Sig ab G Date
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