HomeMy WebLinkAbout1821 Golden Willow Ct - Applications/Reroof - 06/06/2012Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740 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 ❑ 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 #
For offlce use only
Incomplete applications will not be accepted
Date
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Job Site Address (required) &o s z 8, Value of Construction (labor, materials, profit)
1 Garge" \041 cr pqc, 1 $ 32 S
S
Property Owner Name
Address
City/State Zip
Phone
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LISA tC�
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Applicant Name
Address
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
S-0(l N.crc-3
S14 Cco SOSZN
9 St. Y-'7vs
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report?
❑ Here A Report
Sales tax number is required by all contractors
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Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: z4 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 plior 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.
Subcontractor:: 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: A�
Print Name: 1 "" G'a'" Signature
Date 6-6 -/ Z