HomeMy WebLinkAbout1337 Iva Ct - Applications/Reroof - 08/01/2014City of o
ns
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 (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 # 1:�) ( Ll U Lf a S--r-- Date
For ol9'ice use only
Sob ite Address (required
Value of Construction (labor, materials, profit)
537 7 a r r
Pro erty Ovyner N me
Address n�
city/state Z Phone
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60 5
Applicant Name
L f G-zo3
Address
I City/State Zip Phone
Contractor
Address
I . City/State Zip Phone 97D -
11 -
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Contractor City of Ft. Collins Sales Tax #
Are you.paying taxes here or by report? /16 Here ❑ Report
No
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑Yes ,D
r
Is this a residential or commercial project? KResiclential O Commercial
If residential, is it: Single Family Detached ❑ Condo/t6wn6rie (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑, Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )!(No if yes, you may need In contact Hi!
If this is for a demolition permit, what year was the building constricted?
if prior to 1975, you will need an asbestos assessment to submit with `this application.
❑ Duplex
❑ Retail
PreseruaGon
Description of work i'En r`
a Ofe
*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
Electrician Plumber Mechanical 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. Z
Print Name: _ Signature '—Date