HomeMy WebLinkAbout702 Gilgalad Way - Applications/Reroof - 06/26/2012Jun 26 12 02:39p
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City/ Of
Frt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fat 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 #y 09 Date 3
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone 9'16
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ApplicaheName Address
C"State Zip
Phone Q-7a
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Contractor J Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here 0 Report
Safes taxnumberesrequkedbya#contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? 10 Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotef/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Q Yes ❑ No Ifyes, you may need to contactf§stoficPreservation
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 WO this application.
Description of work Es wco uQ
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCty orR Collins license 0
Sectridan 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 abd state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. ;
Applicant: r,
Print Name: .�n;i,j �,G uftl 11 tz SignatureY. G Date 6 2 6 %/ Z