HomeMy WebLinkAbout6851 Kaslam Ct - Applications/Reroof - 09/20/2011Planning, Development &Transportation
C+tytOf 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61?4
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 # ' o Yi o 1 /e/�S 1�Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
(310) m
655l Vlod
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
L303 5DI
Contractor Address
Clty/State Zip
Phone
Contr r City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here
❑ Report
saiestax numberismqulradbyaiiron&` rwps.
Are you paying with your trust account? ❑ Yes
KNo
Is this a residential or c mercial project? Wtesidential ❑ Commercial
If residential, Is It: ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office Cl Retail
❑ Restaurant ❑ Other (explain)
Is this bullding 50 years of age or more? ❑ Yes ❑ No 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 wi// need an asbestos assessment to submit with th/s appllcatiom
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: Llst the company name or Clty of Collins Acense 0
Electrldan 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: cc ��/
Print Name: I CJ�' Lam" Signature Date )I
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