HomeMy WebLinkAbout401 Stover St - Applications/Reroof - 06/11/2012 (4)Fart Collins
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 Aloofing ❑ 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 #
For office use only
Date OzIlb 2
Job Site Address (required) Value of Construction (labor, materials, profit)
qo ) S�oy r- TO U 5 $ Coo
Property Owner Name Address
City/State
Zip
Phone
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Applicant Nam Address
City/State
Zip
Phone
Contractor Lic # 1-1�3 Address
City/State
Zip
Phone q1�
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Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here )d Report
Sales tax numbe-isreQuiredbyalimnoacmm
Are you paying with your trust account? $ Yes
❑ No
Is this a residential or commercial project? 0 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 El 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 cvntactH&oric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you W11 need an asbestos assessment to submit with this application.
Description of work
4
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must li licensed el clan.
Subcontractors: list the company name or city of Ft Collins license # ���
Electrician Plumber Medianical 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:
Print Name: Signatures Date 0�//-/L
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