HomeMy WebLinkAbout1025 Oxford Ln - Applications/Reroof - 08/05/2014 (9)Planning, Development & Transportation
City
Of 281 N. College Ave P.O. Box 580
Forr` Collins 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 ❑ 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.
Application # a )I �CS I Date 09 - 0 6 " / 4 C(6 ' bQ-
For office use only
Job Site Address (r trired)
1 ICI
f7 Value of Construction (labor, materials, profit)
Op
Property Owner N me
Address
City/State Zip
Phone $ �—
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I r re
i �. Cv� .
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ican Name
Address
City/State Zip
Phone 7�iIl
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Contractor.
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
salestaxnumber isrequired byall contractors
Are you paying with your trust account? ❑Yes
�VNo
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: Am
ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
ultifamily (apartment) ❑ Garage
If commercial, is it:ank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain
Is this building 50 years of age or more? ❑ Yes 9,No If yes, you may need to contact Historic Preseruatlon
If this is for a demolition permit, what year was th6 building constructed?
If ptior to 1975, you will need an asbestos assessment to submit with this applicatlon.
Description of work
*If lawn sprinkler/backFlow preventer,
Subcontractors: List the company n
Electrician Plumber.
�list licensed plumber. If first-time A/c, muse list licensed electrician.
or City of Ft Collins license # Loc "4:21
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.
Applicant:
Print Name: l Signatu 2/ Date
3