HomeMy WebLinkAbout1924 Oakwood Dr - Applications/Reroof - 03/28/2012CityOf Planning, Development & Transportation
C } 281 N. College Ave P.O. Box 580
` Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 �O
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 # bJ ),C) (5-) y Date �Z8/ 1Z
For olhce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
ZA ot4W oob - Vr-, I $ Z-So O0 ° D
Property Owner Name Address City/State
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Zip
66W
Phone
17o-ZIG-3q�6
Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? b-lere ❑ Report
sales tax number is required byall contractors.
Are you paying with your trust account?
❑ Yes ANo
Is this a residential or commercial project? ,,Residential ❑ Commercial
If residential, is it: A 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work " d FlfX15V A TCK9 `,WL4LI�r_ 9 (_OM'o51T1N
1�I1
*If lawn sprinkler/backflow 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 #
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: 0 3 Z$ I Z
Print Name: -� �-� I Signature Date