HomeMy WebLinkAbout318 E Oak St - Applications/Reroof - 05/01/2012City f Planning, Development & Transportation
Fy o281 N. College Ave P.O. Box 580
ort 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 ❑ 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 #-?,J 1 4 6 a Date
For offlce use only
]ob Site Address (required) Value of Construction (labor, materials, profit)
�I$ E Ak SX. es $ 2.b C>9 D-
Property Owner Name
Address
City/State Zip
Phone
IV-.
-6 . a raa
970 YT3 I Z o
Applicant Name
Address
City/State Zip
Phone
Contractor Uc #
Address
City/State Zip
Phone
S'nC
oN P.c -;
F4 co $o424
`I S69-7
Contractor City ol Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here 69 Report
Sales tax number is required by allconbactors
4N653
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ACommercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office Qk 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Qe-v cA,..yb4gs AL,� , pr-�l n G (3�,A 37
*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 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: Q.OLA 6A. R � Signature Date S- 1 L