HomeMy WebLinkAbout2418 Cochetopa Ct - Applications/Reroof - 03/29/2012Fort Collins
Planning, Development rat 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
D Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # ?Jk 20��51 �±
For ofilce use only I
Incomplete applications will not be accepted.
Date Z-- Z `, — / 2-
Sob Site Address (required) Value of Construction (labor, materials, profit)
;. y 1 g CQc1 ,e+Q pQ Ct- $ 2.70A OD
Property Owner Name
Address
City/State Zip Phone
q l? COCIN
CD sosas yN?�- sys
Applicant Name
Address
City/State Zip Phone
Te` i n
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yd - co go53 6� 7-126
Contractor
Lic # Address
City/State Zip. Phone
ate
117 -5
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? )J Here ❑ Report
Sales tar number is required by all contractors
Are you paying with your trust account? 0 Yes No
Is this a residential or commercial project? 11 Residential ❑ Commercial
If residential, is It: 121 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 A No If yes, you may need to cvdtact HZstoric Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you w/11 need an asbestos amassment to submit with this application.
Description of work ^-'R it —
*If lawn sprinkler/backflow.preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
Electrician Plumber Mechanical Roofer DOW
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.
Aplicant-Print Name �� 1�1 Signature),tv,Date 3 r