HomeMy WebLinkAbout1324 Ticonderoga Dr - Applications/Reroof - 08/01/2014CI Of Planning, Development & Transportation
Fort Conine Fort N. College Ave P.O. Box 580
.7 Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
ft
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 server change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement NRoofing ❑ 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 # S1��oo Z
For office use only
Date V / /,Zy
Job Site Address (required)
Value of Construction (labor, materials, profit)/yj o
GPM 'hz4a8efnjcA Dt,
Property Owner Name Address
City/ to Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of R. Collins Sales Tax #
❑ "lo
Sales tax number is required by all contractors
Are you paying with your trust account?
Yes
Is this a residential or �op�merdal project? [5 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 ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes KrNo If yes, you may need 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 td submit with this application.
Description of
*If lawn spr r�i der/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # OL,� n
'Electrician Plumber Mechanical —,Roofer e-r—P Other
I hereby acknowledge that I have read this application and state that the
comply with all requirements contained herein and city ordinances and st
permit is not valid until it has been paid and issued.
Applicant: pp ,,//
Print Named mn /a^JI'1P.r
Information is complete and correct. I agree to
s regulating building construction. I know that a
Date <