HomeMy WebLinkAbout655 Justice Dr - Applications/Reroof - 08/23/2014Aug 2314 06:57a
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City of Planning, Development & Transportation
i> 281 N. College Ave P.O. Box 580
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�` Collins Fort Collins, 00 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 #' PLAD (9qq�l Date Z3 i
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 5j"( ?U
Phone q %p-
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Applicant Name Address
city/State El- 42 "F►IlZip J0Jt}%
Phone
Contractor �) Address
I City/State m r Zip l
Phone m m
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? ❑`Here ❑ Report
salestax numderisrequrredbyall contractors-
Are you paying with your trust account?�es
❑ No
Is this a residential VFlngle
erciai project? Residential ❑ Commercial
If residential, is it: Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other ( air
Is this building SO years of age or more? ❑ Yes o Ifyes, you mayneed to contact Historic R eseivatron
If this Is for a demolition permit, what year was building constructed?
Ifpdor to 1975, you wail need an asbestos assessment to submit ralttr this application.
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*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the mmpanyname or City of Ft Collins license #
Electridan 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 and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. A
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