HomeMy WebLinkAbout1212 Live Oak Ct - Applications/Reroof - 08/13/2014City of Planning, Development & Transportation
F Yt Conine For N. College Ave P.O. Box 580
- �.' '`. Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY � 138 • $°
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' Poofing ❑ 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 # ?-:> 14y ant b Date g" 3-
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Nam Address
j City/State Zip
Phone
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Applicant Name Address
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City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Are you paying with your trust account?
0 Here ❑ Report
❑ Yes K No
Sales tax number is required by all contractors
i
Is this a residential or commercial project? [Residential, O Commercial
If residential, is it: Single Family Detached ❑ Cond8/to,,6home (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑{ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes )!(No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with'this applrcabon.
Description of
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If firs
Subcontractors: bst the company name or city of Ft Collins Ilene #
Dectridan Plumber Medianiml_
A/c, must list licensed electrician. 1547
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: ___ff(jjj___ Signature { Dam