HomeMy WebLinkAbout1025 Oxford Ln - Applications/Reroof - 08/05/2014 (2)Ca-J�23
Fort Collins
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 '4.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.
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Date
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Application #
For office use only
Value of Construction (labor, materials, profit)
Sob Site Address 6 wired)
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Property Owner N e Address
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City/State
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licant Name Address
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Contractor City of FL Collins Sales Tax #
Are you paying with your trust account? ❑ Yes No
salesraxnumberisrwaredbyallconvactorx
is this a residential or commercial project? ❑ Residential ❑ commercial
If residential, is it: 2.Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
p"ultifamily (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 was the building constructed?
If plior to 1975, you wi/l need an asbestos assessment to submit with this application.
Description of work
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*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license # eo2 - IoZ2
Electrician „
Plumber Mechanical Roofer Other
I hereby acknowledge that.] 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 ate laws regulating building oonstrudion. I know that a
permit is not valid until" it has been paid and issued.
Applicant: c I signature
Print Name:. r