HomeMy WebLinkAbout4807 Crest Rd - Applications/Reroof - 09/25/2014a5
Planning, Development & Transportation
city Of 281 N. College Ave P.O. Box 580
F®r't 7'ow l5 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 ❑ 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 # '—b14 ) 30
For office use only
Date 4- 25=/ y
Job Site Address (required)
Value of Construction (labor, materials, prof L/ /OO. 1
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Projperty Owner Name Address
City/State Zip
Phone
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Applicant Name
City/State Zip
Phone
n �Address
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Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
trust account? Arles
❑ No
Sales tax number is required by all contractors
Are you paying with your
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Is this a residential or.com ercial project? .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 5o years of age or more? ❑ Yes Xf4o 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 to submit with this application.
Description of work
*If lawn sprinkler/backflow 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 # l({, r I�Aw
Bectridan Plumber Mechanical Roofer A z 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:
Print Name:: Signat a Date
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