HomeMy WebLinkAbout1025 Oxford Ln - Applications/Reroof - 08/05/2014 (13)Planning, Development & Transportation
Fcity af
ort Coll For N. College Ave P.O. Box 580
Fort Collins, CO 80524
1
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 34 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation q Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # h14QG✓i50
For office use only
Sob Site Address
Property Owner Na(he Address
r"e
Address
Incomplete applications will not be accepted.
Dates I�-1 �3
Value of Construction (labor, materials, profit)
City/State Zip
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Phone 7-2Q
Phone
Contractor City of Ft. Collins Sales Tax # Are you paying with your trust account? ❑ Yes XNo
sales tax number is required by all contractom
is this a residential or commercial project? ❑ Residential ❑ Commercial ❑ Duplex
If residential, is it: Single Family Detached 0 Condo/townhome (single family attached) P
giWultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank [I Bar ❑ Church ❑ Hotel/Motel ❑Medical office ❑Office ❑Retail
❑ Restaurant ❑ Other (explai )
Is this building So years of age or more? ❑ Yes No If yes, you may need to contact HisYaric Preservation
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you will need an asbestos assessment to submit with this appliradon.
Description of work
e
*If lawn sprinider/back low Preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list Me company name or CRY of ft Collins license #
Electridan Plurnf�er
Mechanical Roofer
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: t' G Signature r Date
Print Name: