HomeMy WebLinkAbout1612 Quail Hollow Dr - Applications/Reroof - 04/24/2012Fort 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 ❑ 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.
Application # ���Z��2.'L�J� Date Wj `c?q `�oC
For office use only
Job Site Address (required) p j� Value of Cons�r.�ction (labor, materials, profit)
11/71� (Iia a�( nI �mt�,l $ '_0 �' )
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Lic # Address
City/State Zip
Phone
,Cpntractor
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Contractor City & Ft. Collins Sales Tax #
Are you paying taxes here or by re ort? ❑ Here eport
Sales tax number is required by allconhactors.
Are you paying with your trust account? ❑ Yes No
Is this a residential or co mercial project? )litesidential ❑ Commercial
If residential, is it: mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
1*10 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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th uilding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
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*If lawn sprinkler/backflow preventer, mWt list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
-74 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: 11` r%
Print Name: �rl t natur to