HomeMy WebLinkAbout1025 Oxford Ln - Applications/Reroof - 08/05/2014 (3)Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
F6r't CoWns. 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 j24cofing ❑ 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. # 9)14050�)_q 9 Date C z - Os — l q
For office use only
Job Site Address (r quired)
Value of Construction (labor, materials, profit)
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Property Owner me Address
City/State Zip
Phone —
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N e � r Address
City/State Zip
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City/State Zip
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Phone
Contractor City of Ft. Collins Sales Tax #
sales tax number isrequired byall contractors
Are you paying with your trust account?
❑Yes to
Is this a residential or commercial project? ❑Residential ❑ Commercial
If residential, is it: ❑ ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 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 waste building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacldlow prevented, must list licensed plumber. If first-time A/C, m must li st incensed electrician.
Subcontractors: List the company name or City of Ft Collins license # � �` J
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. .. r
Applicant: V I,/�
Print Name: C� Signature
Date 4U6—
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