HomeMy WebLinkAbout2636 Bison Rd - Applications/Reroof - 08/06/2014Planning, Development & Transportation
City Of I 281 N. College Ave P.O. Box 580
�` COL`II r� IS 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 service change) ❑ Gas. Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement KRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). Ia.
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Date
For office use only
Job Site Address (required)
Value of$ Construction (labor, materials, profit)
Property Owner Name
Address
Ci State Zip
Phone
Applicant me
Address
City/State Zip
Phone
°I G�
Vi -
Contractor
Address
City/State Zip
O'Phone
Contractor City of 117t. Collins Sales Tax #
Are you paying with your trust account?
❑ Yes ❑ No
sales tax number is, required byall contractom
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: IR 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 'RNo If yes, you may need to contact Historic Preservadon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Descripti n of rk
*If lawn sprinkler/backnow 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 #
t{ `
Electrician Plumber Mechanical Roofer WQ 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: (C��d ��
Print Name: signature Date v �,-_ _ 1
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