HomeMy WebLinkAbout5320 Fossil Ridge Dr - Applications/Reroof - 08/21/2014Ci of Planning, Development & Transportation
F6ry Collins For N. College Ave P.O. Box 580
1� 1 i Fort Collins, CO 54 Q '
Phone 970-416-272740Fax 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 # & 146V�s
For office use only
Date oL/,-/Y
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
Applica'n/tt Name
Address
City/State Zip Phone
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Contractor
Address
City/State Zip Phoorree _
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Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report? ❑ Here ❑ Report
Sales taxnumr&rWulredbya!!contactors
Are you paying with your trust account?. ❑ Yes ❑ No
Is this a residential or cojnmercial project? GliResidential ❑ Commercial
If residential, is it: EISingle 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you w111 need an asbestos assessment to submit w/th this application.
Description of work -r—hW eocys' Y`- o'c /Cm m k A9 ,l r? u Aa-4-z S
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*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 4C X- !�DK 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
Print Name:z� �t% IV, c ele1/ signature Date OF cZ/ —/ 5'