HomeMy WebLinkAbout2625 Bison Rd - Applications/Reroof - 08/26/2014City Of [j Planning, Development &Transportation
##6 C®ill ns For N. College Ave P.O. Box 580
F®r
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 dpi�B
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 # 7-:;0V--® Le C1 871 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address
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C'ty/State
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7 Zip Phone') 10
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Applicant Name Address
City/State
Zip Phone
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Contractor n (' Lic # Address
City/State
lZip/ Phone 3�
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here
or by report? ❑ Here 14 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? ILL
If residential, is it: RfSingle Family Detached
❑ Multifamily (apartm`ent)
Residential ❑ Commercial
❑ Condo/townhome (single family attached)
❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other(explaiq)
Is this building 50 years of age or more? ❑ Yes [lyo If yes, you may need 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 of work
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*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: n ^� -�
Print Name: l7t,l A rt4,L' Signature
Date A