HomeMy WebLinkAbout4725 Venturi Ln - Applications/Reroof - 09/17/2014�of
t Collins
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 spryce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Hoofing ❑ 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 # $I —I b,bsUb
For oliice use only
Date 9I I
Job Site Address (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
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Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Collins Sales Ta
Are yo
aying taxes here or by report?'�Fk Here ❑ Report
Sales taxeris required by all contractors
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Are you paying with your trust account?
❑ Yes � No
Is this a residential or commercial project? I"esidential ❑ 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 (ex la' )
Is this building 50 years of age or more? ❑ Yes Ifyes, you may need to contact 8istor/cPreservation
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 /
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:^ O�
Print Name: lJ�✓ ri-- Signature l!" �-V �-�� � Date
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