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HomeMy WebLinkAbout4123 Stonegate Ct - Applications/Reroof - 08/15/2014Ici Fort Collins OVER-TH This application is to be used to apply for the f ❑ Demolition (interior non-structural) ❑ Electrical ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horr ❑ Ventilation ❑ Water Heater ❑ Water Line ❑' manufacturer). Complete all applicable information on the app Application #. For office use only Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 PERMITS ONLY lowing permits only (check all that apply). ❑ Air Conditioning Iteration (not service change) ❑ Gas Lighter ❑ Gas Log replacement IV Roofing ❑ Sewer Line ❑ Photo -voltaic Stove (must be EPA certified, provide make, model and Incomplete applications will not be accepted. Date q" )�- ) L/ Sob Site Address (required) Value of Construction (labor, materials, profit) q1Z S,owGG-ATE ��- 1©, 137. 9Q, Property Owner Name Address City/State Zip Phone tDow Applicant Name Address ! City/State Zip Phone Contractor Address City/State Zip Phone ��E 5 rzc ssCtN WOO 86S39 . '-; 1 I Contractor City of Ft. Collins Sales Tax # j Are you paying taxes here or by report? N Here ❑ Report Sales tax number isrequiredbyall contradors, Are you paying with your trust account? M Yes ❑ No ys8�� Is this a residential or commercial project? ® R If residential, is it: ® Single Family Detached ❑ Multifamily (apartment) If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Restaurant ❑ Other 6 entiai ❑ Commercial Condo/townhome (single family attached) ❑ Duplex Garage Hotel/Motel ❑ Medical office ❑ Office ❑ Retail Is this building 50 years of age or more? ❑ Yes �* No Ifyes, you may need to contact HistoocPreservation If this is for a demolition permit, what year was thl building constructed? If prior to 1975, you will need an asbestos assessmeptto submit wifte this application. Description of work 9<EMBvE SytN *If lawn sprinider/backfiow preventer, must list licensed Subcontractors: List the company name or City offt r Electrician ON If first-time A/C, must list licensed electrician. i inslicense # Mechanical Roofer I\— IJr I 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 qdinances and state laws regulating building construction. I know that a permit is not valid until it has been paid and issu Applicant: Print Name: 6 �� L (;S'r �e _ 7a>,�J U&W,SignatureDate a20 q