HomeMy WebLinkAbout1400 Ticonderoga Dr - Applications/Reroof - 07/23/2014City of Planning, Development & Transportation
Fort Collins For 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
❑ 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 # i yd y� Date 749-V!4
For office use only I
Job Site Address (required) .
Value of Construction (labor, materials, profit)
i400
r
3 oiod
Property Owner Name
Address
City/State
Zip
Phone
P a 0 le -66
1
eeo ;9
�b3_25
--*Izc? .-241G 0.
Applicant Name
Address
ity/State
Zip
Phone
Contractor
Address
City/State
Zip
Phone
PP,o QO I
5 C (f
ti 305A?
407-(?067
Contractor City of Ft. Collins Sales -(ax
#
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes -M No
Is this a residential or commercial project? R Residential ❑ Commercial
If residential, is it: 1g 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.
of work
A
rQ
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electriOn.
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: ,�//� Cc,,CC %�%/ * 7
Print Name: �� w�7A&4 Signature D,t�VaK-C lfC-4 Date ! 23