HomeMy WebLinkAbout1025 Oxford Ln - Applications/Reroof - 08/05/2014 (8)Ca-/�23
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970416-2740 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 ')ZRoofing ❑ Sewer Line ❑ Photo voltaic
❑Ventilation 0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). ti will not be accepted.
Complete all applicable information on the application.
Application # V) 14 bJ� lP
For office use only
Job Site Address
Property Owner Natne Address
Contractor City of R. Collins Sales Tax #
Saes tax number is required by all contracts
Incomplete appltca ors
Date fi k - I_� 4 I 13
Value of Construction (labor, materials, profit)
City/State
t�e Iud
City/State
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Are you paying with your trust account? ❑ Yes
Phonep7
Phone
Phone
XNo
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: j],Single Family Detached [ICondo/townhome (single family attached) ❑ Duplex
j�lultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain
Is this building 5o years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was building constructed?
if prior to 1975, you will need an asbestos assessment to submit with ifics application.
Description of work
e
*If lawn sprinkler/bacidlow preventer, must list licensed plumber. If first-time A/C, must list lidensed electrician.
Subcontractors: List the company name or (31y of lt Coffins license �
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Electrician.���
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 rued.
Signature L
Print Name: 6iU�D
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