HomeMy WebLinkAbout1025 Oxford Ln - Applications/Reroof - 08/05/2014 (6)Ca-1-a-23
Fort Collins
Planning, Development 8c Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -THE -COOKER 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 'J� Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all applicable information on the application.
Application # b14 D,5�9 K
For office use only
Job Site Address
Property Owner Naf�e Address
-e
Address
Incomplete applications will not be accepted.
Date h di - /4 1 `'1-1 , 13
Value of Construction (labor, materials, profit)
7/91 6
City/State ZIP
r
Zip
2M
Phone 7-26
Phone
Contractor City of FL Collins Sales Tax # Are you paying with your trust account? ❑ Yes IXNo
Sales tar numbers mqui2d by all conbacorx
Is this a residential or commercial project? ❑ Residential ❑ Commercial I
❑ Du lex
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) P
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar [I Church ❑ Hotel/Motel ❑Medical office ❑Office ❑Retail
❑ Restaurant ❑ Other (explai )
Is this building 5o years of age or more? ❑ Yes �No If yes, you may need to contact Histonc Prese^rabon
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you will need an asbestas assessment to submit with this application. ^
Description of work
!i
0
*If lawn sprinkler/baddiow Preventer, must list licensed plumber. If first-time A/C, must liselicensed electrician.
subcontractors: List the company name or Gty of Ft Collins license #
Electrician Mumber
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 cafe laws regulating building construction. I know that a
permit is not valid until it hats been paid and issued.
j J- '1) L
.
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Applicant ; P Signature Date -/
Print Name: