HomeMy WebLinkAbout3343 Santa Fe Ct - Applications/Reroof - 05/14/2012City of
Flirt 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 # b C�q I Date S /5/ ^ / 2
For office use only -1 ,
Job Site Address (required) Value of Construction (labor, materials, profit)
3�3y3 SaNfe Fe c-+ 1 $ 22 syq
Property Owner Name
Address
City/State
Zip
Phone
w ci r 3
S`a'Fe
C-1
Applicant Name
Address
City/State
Zip
Phone
Cf �->o -er`r 27/�l u-'. 1A q f44ri
FC ry
8a-5-2 (
-2 3 S rl0 3
Contr)a1ctor lac #
Address
City/State
Zip
Phone
Sl�e (TPr Rd 01 1 si5 0 75
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here "Report
sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: .R 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work e,<;5 4s ,*j 7 r h i w
*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 infprmation 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: 1
Print Name: lee "i ��� * / f Signature Date S / V /2