HomeMy WebLinkAbout2107 Barnwood Ct - Applications/Reroof - 08/28/20146 5-60-1%\
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Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
Fort 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 sere ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement K,,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.
Application # �Q40-7t)Lo`7
For office use only
Incomplete applications wI not be accepted.
Date
Job Site Address (required)
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Value of CIt ction (labor, materials, profit)
o s
4c500.06
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Property Owner Name
Address City/State Zip
C'f 06 9US25
Phone riy%G
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5610 2
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Applicant Name
Address City/State
Phone
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llZip
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Contra orb
Address n City/Staatefj Zip
PhonE
Contractor City 8f Ft. Collins
ort
les Tax # Are you paying taxes here or by report? ❑ Here (M01
Sales tax number is required by all contractors Are you paying with your trust account? El Yes
0G� 1 ';)- 1 ?4-7 -7
Is this a residential
If residential, is it:
If commercial, is it:
o.�9qmmercial project? Residential ❑Commercial
15-9ngle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other(elplajn)
Is this building 50 years of age or more? ❑ Yes ,hAo Ifyes, you mayneed 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 Qf wor�QiY e
*If lawn sprinkler/t(ackflow 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 a 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: Ke
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Print Name: I Signature _4Y Date