HomeMy WebLinkAbout4524 Bluefin Ct - Applications/Reroof - 06/07/2012City Of Planning, Development & Transportation
F6C Y 281 N. College Ave P.O. Box 580
�rt 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 )E�800fing ❑ 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.
Application #
For office use only
Incomplete applications will not be accepted.
Dated— I—�v
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone ll LL
—�q7�D
o'l e0 nor
Applicant Name Address
City/State Zip
Phone
tractor Lic # Address
City/State Zip
; Phone
o
) -74 _12-
Contractor City of R. Ins Sales Tax #
Are you paying taxes here or by report?
❑ Here
.Sa/es tax number is required by all contractors
Are you paying with your trust account?
_O<eport
❑ Yes
Is this a residential o cornmercial project? C�tesidential ❑Commercial
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 ❑ 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.
work
*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: Signature
Date 6 z� /�