HomeMy WebLinkAbout5201 Coralberry Ct - Applications/Reroof - 07/10/2014City of
F6rt 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
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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/Pelldt Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # FR I AV2 �-J In Date 7-l0'�Y
For office use only
Sob Site Address (re uired) /
Value of Construction (labor, materials, profit)
201
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone 9y0
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
sales tax number isrequired byall contractors
Are you paying with your trust account? ❑Yes ,SfNo
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Is this a residential or commercial project? Residential' ❑ Commercial
If residential, is it: KSingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑i Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes KNo If yes, yi
If this is for a demolition permit, what year was the building constri
Ifpnor to 1975, you will need an asbestos assessment to submit with
Description of work
❑ Duplex
❑ Retail
may need to contact Historic Preservation
application.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. 2
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:
Print Name: Signature Date