HomeMy WebLinkAbout3036 Antelope Rd - Applications/Reroof - 08/11/2014Aug 11 1412:40p
p.22
City of
��t Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-274o 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 (nterior non-structural) ❑ Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 17 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 17 Water Une ❑ 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-o `1J !/(! rl t) I�� no lot j Date
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Job Site Address (required)
Value of Construction (labor, materlafs, profit)
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Property Owner Name Address
City/state Tip
Phone
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Applicant Name Address
Gty/State zip
Phone
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Contractor Address
City/State Tip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
sa�esrarnumbertsraywreebyanca„tracaws
Are you paying with your trust acoount?-Pf�es
D No
e -zCco
Is this a residential F-Mntc
ercial project? idential ❑ Commercial
If residential, is it: e Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
ifamily (apartment) la Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
C! Restaurant ❑ Other (explai )
Is this building SO years of age or more? ❑ Yes No Ifyes, you mayneed tomnAxtHlZowPm-viva bon
If this Is for a demolition permit, what year was t bu rng constructed?
lfprwrto 1975, you will need an asbestos assessrnentto submit wb1 ibts app/icabon.
Description of work
*If lawn sprinkii r/baddlow preventer, mush list licensed plumber. If first-time A/C, must list licensed electridarL
Subeontsactors:11stDre compaWname orcity ofRCollinsI&Wse #
ElecRidan Plumber hfeahanlml Rooter Other
I hereby acknowledge that I have read this application and date 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 brow that
permit Is not valid until it has been paid and issued.
Print Name."Signature
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