HomeMy WebLinkAbout2525 Flintridge Pl - Applications/Reroof - 04/02/2012City.Of Planning, Development & Transportation
�.281 N. College Ave P.O. Box 580
F OI t Collins'
Fort Collins, CO 80524 _ll�p
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 XRoofing ❑ 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 #
For office use only
Date o; Apr 1 A
Sob Site Address (required)
: 1
Value of Cgpstruction (labor, materials, profit)
Fa co s-a SD
Property Owner Name
Address City/State Zip Phone
�d ;n I� (I I Cz
?l F4-C 86s a 1 -769
Applicant Name
Address City/State Zip Phone "aw
AWA
asro oak Am, Dwwr ftW4 9 "" nets
Contractor
Address City/State Zip Phone
Wawa
2570 LAB* Am, 0TVW ft2b4 2113-7443
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
❑ Yes )6o
sales taxnu3¢erIWbyall ronbactors
Are you paying with your trust account?
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ 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 )IMo 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 wi/l need an asbestos assessment to submit with this application.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of ft Collins license # Electrician Plumber Mechanical Roofer 1Z -= Other
I hereby acknowledge that I have read this application and state that
comply with all requirements contained herein and city ordinances an
permit is not valid until it has been paid and issued.
Applicant: i , _•�� • • _�� AW
Print Name: �� L�.�
we information is complete and correct. I agree to
laws ryyulating building construction. I know that a