HomeMy WebLinkAbout1236 Columbine Ct - Applications/Reroof - 04/02/2012Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
c
�t Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 /►
OVER-THE-COUNTER PERMITS ONLY 3
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.
Application #�E4'2:6 16 e-;5—
For office use only
Incomplete applications will not be accepted.
Date y - Z — i Z
lob Site Address requ'red)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/Statey Zip
Pho
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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?
❑ Here KReport
Sales tax number isrequiredbyall contractors.
Are you paying with your trust account?
❑ Yes VIeNo
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: Q'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 JtKNo 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
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time,&V, 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: Sjqys
Print Name: l
Date '7' -Z—)