HomeMy WebLinkAbout100 Palmer Dr - Applications/Reroof - 07/28/2014Planning, Development & Transportation
City/of 281 N. College Ave P.O. Box 580
F6r`}Collins 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 10 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 #_Bi1i-0+5w Date 28 20k `
For office use only
Job Site Address (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone 1110
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Applicant Name Address City/State Zip
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Phone 400
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Contractor Address
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City/State Zip
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Phone 000
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Contractor City of Ft. Collins Sales Tax #
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Are you paying with your trust account? YYes ❑ No
sales tax number is required all contractors
# S2G4t
Is this a residential or commercial
project? W Residential ❑ Commercial
If residential is it: Iff 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 IfNo 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 wlll need an asbestos assessment to submit with this application.
Description of work
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 -23 3q 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: QCJ �e j[ O N. Signature
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