HomeMy WebLinkAbout2200 Valley Forge Ave - Applications/Reroof - 08/27/2014 (4)City of Planning, Development & Transportation \
F`Collins For N. College Ave P.O. Box 580
ort
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 \
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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 .1lioofing ❑ 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 # Pr�f�7�aa Date
ror once use only
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Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name
City/State Zip
Phone ODD
��Ad``drress
Ap icant Name Address
City/State Zip
Phone (97 o)
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Contractor Lic # Address
City/State Zip
Phone (-'?70)
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Contractor City of Ft. Cibfins Sales Tax #
Are you paying taxes here or by report? .!N�Here
❑ Report
sWes tax number is required by all contactors
Are you paying with your trust account? ❑ Yes
tkNo
Is this a residential or commercial project? EI�Resldential ❑ Commercial
If residential, is it: �VSingle 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 Ma Jo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pr1or 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 #
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.
Applicant: / - //J�
Print Name:/—� �r�/M�7_$ignature v ✓ Date