HomeMy WebLinkAbout749 Benthaven St - Applications/Reroof - 08/12/2014City/ of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 �7 V
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 # � 40%4-02) Date
For office use only
Job Site Address (required)
749 BENTHAVEN ST
Value of Construction (labor, materials, profit) $5,200
Property Owner Name
JOE & JOSELYN ROBERTS
Address City/State Phone(970)692-1265
Applicant Name
JUVENTINO ORNELAS
Address City/State Phone(970)430-2651
Contractor
TOTAL REMODEL CONTRACTOR
Address 2006 8T" ST City/State GREELEY CO Phone(970)352-9988
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? el Here ❑ Report
Salestaxnumberisrequiredbya//contractors.
Are you paying with your trust account? ❑ Yes ❑ No
90-0736417
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: X 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 X No Ifyes, you mayneedto contactHistoricPreservation
If this is for a demolition permit, what year was the building constructed?
Ifpriorto 1975, you willneedan asbestosassessmenttosubmit with thisapplication.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the companynameorCityofFtCollinslicense#
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:
Print Name: JUVENTINO ORNELAS Sig ure Date 8/12/2014