HomeMy WebLinkAbout3021 Cortez St - Applications/Reroof - 08/29/2014City 0f Planning, Development & Transportation
¢ m 281 N. College Ave P.O. Box 580
ForL Collins Fort Collins, CO 80524
Phone 970-416 2740 Fax 224 6134 'J, 400
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 # ?i 1-4-0-11 D-7 Date
For ofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip Phone
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S 16 - 15-51Q-75
Applicant Name
Address City/State Zip Phone
Contractor
Address City/State Zip Phone
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2'A S S. &Lo"DD &LO D6114zZZ. 3 8a D 3,03
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax umberisrequiredbyall contractors,
Are you paying with your trust account? ❑ Yes ❑ No
ly T" 13
Is this a residential or commercial project? O-Residential ❑ Commercial
If residential, is it: PI -Single 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 (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensedplumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
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.
Applicant:
Print Name:Z>4�%VritS 'i�(toLL3113 Signature Date