HomeMy WebLinkAbout3209 Yellowstone Cir - Applications/Reroof - 08/11/2014City
Fort of
/00
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort 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 0 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.
Application # 1�> 1 Ll-O Sl n6p
For o>fIce use only
Incomplete applications will not be accepted.
Date 6—/1J1y
ob Site Address (required)
Value of Construction (labor, materials, profit)
dlr,6- q76-17
Property Owner Name Address
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Ci /State Zip
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Phone
q70
A plicant Nam Address
Jnh) &h )-,Lc
City/State Zip
Him&" 11) W
Phone
—&A
Contra&d Address
CitA&te Zip
Phone
Contractor City of Ft. Collins Sales Tax #
sales tax numberh;mqulne�byall contractors
Are you paying taxes here or by report?";O'flere
Are-youpaying with your trust account? ❑ Yes
❑ Report
❑ No
Is this a residential yrio�l
mercial project? [7 esidential ❑ 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 ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 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?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Of
*If lawn sprinkler/bacldlow 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 #
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.
Print Name: 2 S Signature Datey� ��.