HomeMy WebLinkAbout3030 Eastgate Ln - Applications/Reroof - 08/11/2014Aug 11 1412:38p
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of
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 O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilafion ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicab4)il�
leinf�jor 1mation o the application. Incomplete applications will not be accepted_
Applicat o <* 11 li J1 b,-(0) 1� [[J Date j% ' 0 01
Fvrofl%e use only
%b Site Address (requked)
Value of Construction (Libor, materials, profit)
Property Owner Name Address
City/state Zip Phone
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Applicant Name Address
citylstate zip Phone
i NUS �Ct't1? {}c- G ee� e '-1
Contractor Address
City/State zip Phone
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sakstaxnumberlerequ/redbya#cantradbm
Are you paying with your trust accountT�es ❑ No
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Is this a residential or co mercial project? idential ❑ Commercial
If residential, is it: ngle Family Detached l7 Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant Q Other (explE
Is thisbuilding 50 years of age or more? ❑ Yes o Ifyes, you nrayneed to cantactfi storicPranwvation
If this is for a demolition permit, what year was t ding constructed?
Ifpriorto 1975, you MY need an asbestos assessment to submit with b sappllcaffon.
of work
*If lawn sprinter/backflow preventer, mush iist licensed plumber. If first-time A/C, must list licensed electrician.
Suboo ntractors:LfstMecompany name orQtyofRCollins hbse e#
Mec4rdan Plurnber MecharkW Roofs 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 a d state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: 149riature4ildPrint Name . [t`'�y
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