HomeMy WebLinkAbout2913 Indigo Cir N - Applications/Reroof - 07/29/2014To: Page 2 of 4 2014-07-30 18:49:28 (GMT) 18663247566 From: Julian Rector
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City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FoftCottins 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). 0 Air Conditioning
0 Demolition (interior non-structural) 0 Electrical Alteration (not servi.9e change) 171 Gas Lighter El Gas Log
n Heating Unit Q 1-awn Sprinkler 0 Mobile Home replacement, b9koofing 0 Sewer Line 0 Photo -voltaic
0 Ventilaticn 0 Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all applicable information on the application. Incomplete applications will not bq accepted.
Application # Date
(61 c
For office use only
3*b Site Address (req Value of Construction (labor, materials, profit)
*1L
Property Owner Name Address Cjty/State Zip Phone
it,
Applicant Name
Address City/State Zip Phone 1.2'C`
Contractor
Address City/State Zip Phone
Contractor CftY Of FL Collins Sales Tax # Are you paying taxes here or by report? 0 Here
Sales tax R'Report
ber aly con&acwrt Are you paying with Your trust account? 0 Yes
7612,5M �111
Is this a residential or commercial project? 13 Residential 0 Commercial
If residential, is it. -'a Single Family Detached 0 Condo/townhome (single family attached) 0 Duplex
13 Multifamily (apartment) 0 Garage
If commercial, is it: 0 Bank El Bar 13 Church 0 Hotel/Motel 13 Medical office 0 office El Retail
0 Restaurant 0 Other (explain) —
Is this building 50 years of age or more? 0 Yes ( 1:"'-o if Yes, you may need to 'contact Historic PreservationIf this is for a demolition permit, what year was the building constructed?
If plvr to 1975 you will need an asbestos assessment to submit with this application,
of work
*If lavin sprIMIderibackilow Preveriter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; Ust the company name or c1ty of Ft Collins licanse
EWCtr'C'*R— Plumber— Mechanical-- Roofer.. 24Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I ogr 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:.
Signature "i