HomeMy WebLinkAbout3807 Arctic Fox Dr - Applications/Reroof - 07/31/2014City,of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FF6rCoWns Fort Collins, CO 80524
`.- Phone 970-41&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 ice 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 # 'E44041 05
For office use only
Incomplete applications will not be accepted.
Date 713 f f EF
]ob Site Address (required)
Value of Construction (labor, materials, profit)
31E7 Ar- iZ:otc
� Oz)
Property Owner Name Address
City/State Zip
Phone
o 10"7A(,
Ec co oszs-
-r-7o-2v(P-b22
Applicant Na a Address City/State Zip
Phone
° m 0JdW-�s''i
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Safes Tax #
Are you paying taxes here or by report?
.0 Here ❑ Report
Sales tax numberisrequired byall con&actors
Are you paying with your trust account? `Yes ❑ No
Is this a residential or co ercial project? Residential ❑ 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?
Ifpiror to 1975, you wit/ need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List lire 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.
Print Mama:(% g q/6j Signature Date
a