HomeMy WebLinkAbout2006 Angelo Ct - Applications/Reroof - 11/10/2011Cityof
Fort Collins
OVER-THE-COUNTER
This application is to be used to apply for the following perry
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet St
manufacturer).
Complete all applicable information on the application. Into
Application #
For office use only
Job Site Address
inning, Development & Transportation
1 N. College Ave P.O. Box 580
rt Collins, CO 80524
one 970-416-2740 Fax 224-6134
ERMITS ONLY
only (check all that apply). ❑ Air Conditioning
vice change) ❑ Gas Lighter ❑ Gas Log
Roofing ❑ Sewer Line. ❑ Photo -voltaic
(must be EPA certified, provide make, model and
> applications w' I not be accepted.
of Construction (labor, materials, profit)
Pro erty Owner Name
i
Address
�IT
d
/State Zip
r S 1rG�
Phone
`2Z - /%G
AP licant Nam
(90 / Ud
Address
/
/State Zip
Phone
Con ctor Lic #
Address
ty/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you
ying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all mnbactars
Are you
ying with your trust account?
❑ Yes ❑ No
Is this a residential or ccorrig2groal project? BlEesidential ❑ Comnercial
If residential, is it: 005ingle Family Detached ❑ Condo/townh a (single family attached) ❑ Duplex*
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel I I Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes i7 If yres, u may need to contact Historic Preservation
If this is for a demolition permit, what year was the building con cted7
If prior to 1975, you w111 need an asbestos assessment to wbmit wi is appl%abcn.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If fin
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical_
A/C, must list licensed electrician.
Roofer /Other
I hereby acknowledge that I have read this application and state that thieibove information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and a I�wsTegulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: �.//
Print Name: ;16,
Date //v1Z
t'd bZ LO£69OL6 -oul 'buifoo�] plot dZ£:t70 l 6 0l AoN