HomeMy WebLinkAbout3233 Chase Dr - Applications/Reroof - 07/23/2014Jul 24 14 06:42a Westers Roofing
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City of
Fort Collins
OVER-THE-COUNTER
9705688448 p.4
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demorttion (interior non-structural) ❑ Electrical Alteration (not service change) O Gas Lighter 0 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 # I S 3 Date -7 - 2 3— l `>`
Fore ice use only
Job A dr (required)
32 C A"-ei
' • value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
City/State Zip Phone
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0-690-0
Contractor
Address
City/State Zip Phone
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Contractor Ccty of Ft Coils s S Tax #
sales tax number is raqulred by aN amtadom
�0877
Are you paying with your trust account? 91Wes ❑ No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: 9&Single Family Detached Q Condo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) ❑ Garage
If commerclal, is It: ❑ Bank ❑ Bar C] Church ❑ Hotel/Motel ❑ Medical ofAce •O Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes Vlo if yes, you may need to contact Historic Prao radon
If this is for a demolition permit, what year was the building constructed?
1f prior to 1975, you W11 need an asbeslas assessment tb submft Wth this appllcatfon. h�
Description of work
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*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-time A/C, must list 11&nsed electrician.
Subcontractors: List the company name or OW of Ft Coffins license #
Electrician Plumber Mechanical Roofer Older
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.
ApOicarib
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Print Name:
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