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HomeMy WebLinkAbout2002 Fossil Creek Pkwy - Applications/Reroof - 06/29/2012City of Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, 16 2740 4g �/©� Phone 970-416-2740 Fax 224-613 �`" `�' 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 # Date Lo 1aq 11D, For office use only Sob Site Address (required) Value of Construction (labor, materials, profit) aa,;? fb-Ss, ( Cv-�eA l�cw 3 360. o a Property Owner Name Address City/State P-TIC Zip Phone Cr 10 LinaQevi kirk . ('S3 %cCleI10 34e 1 00 Co $oSzs 0 ao1r 01?2-2094 Applicant Name Address City/State Zip Phone 4-m A4CWr-&"l,e (2009- a1-1 w rilb 1zs Ffa( Co goS'a9' Contractor Address City/State Zip Phone SrAvv..e. Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sales tax number isrequired byall contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? 10 Residential ❑ Commercial If residential, is it: I 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 conlactHistotic Preservation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit with this application. Descriotion of work es *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Ustthe companyname orCityofRCollins license # Bectridan ' Plumber 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 aid state laws regulating building construction. I know that a permit is not valid until it has been paid and issued. Applicaft Print Name: �I vt\ 1 i l 1� s Signature (� l "U'��� Date 6' �? 1 12_ 1�1't1 ' 7' tt``I rya ,