HomeMy WebLinkAbout312 Pearl St - Applications/Reroof - 04/06/2012City Of Planning, Development & Transportation
281 N. Coege Ave
FOr }` Collins r1 IS Fort Col ns, CO 80524 P.O. Box 580
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.
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Application # -o 1-7 u1 Date � cp I
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Job Site Address (required) Value of Construction (labor, materials, p fit)
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Property Owner Name
Address City/State Zip
Phone
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App Icant Name
Address City/State Zip
Phone
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Contractor
Lic #
Address �� City/Stater Zip
Phone/,
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Contractor City of Ft. Cogns
Sales Tax #
Are you paying taxes here or by report?
Here ❑Report
sales taxnum4e�: "Zr by contractors
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Are you paying with your trust account?
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❑.Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ,Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church Q Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (exp in
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year waste building constructed?
If prlor to 1975, you will 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 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: ��O { ��
Print Name:y Signature ��`L�� Date