HomeMy WebLinkAbout3913 Touchstone Ct - Applications/Reroof - 07/23/2014Fort Collins
Planning, Development & 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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ARoofing ❑ 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 # D14Q -I253 Date �(4r�-
Por office use only
lob Site Address (required) Value of Construcd (labor, materials, profit)
c,�ca700. 0 0
P pertly Owner Name Address Gty/State Zip Phone
KO rt+-�-i'54 73TUMVI. qJ19 rbor alkDr L'011r' ohs 970-1 - 8
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? EXHere ❑ Report
Salestaxnumbierisraqubedbya//mnbact= Are you paying with your trust account? )0 Yes ❑ No
?X1o53 Fo¢t ("ewg6 Iargnlse W Iz-►i6l
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: 12 Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ifs No if yes, you may need to contact H6wric Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit witfi this applicabon.
work
*If lawn sprinklerocldlow preventer, must 1� licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name orCrtyoff`CollinsAcenseA-aa-7`?
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 tD
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: / c ,f _ �
Print Name: F �l►�(L� U�'a Signature babe 2 /