HomeMy WebLinkAbout5209 Greenway Dr - Applications/Reroof - 09/16/2014City Of Planning, Development &Transportation
pay¢ 1� 281 N. College Ave P.O. Box 580
�
F 6 !� C®Lloi 1s 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 eck all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not servic change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement &31TRoofing ❑ 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 # e 1-�®'BdID
For office use only
Date �ro -LL1
Job Site Address (required)
Value of Construction (labor, materials, profit)
5�
J
Property Owner Name Address
City/State Zip Phone
sumbe&3
k4l'
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
_ k
G _
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? Lwlw e idential ❑ Commercial
If residential, is it: mgle 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 o If yes, you mayneed 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 electr ian. t "
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: ✓ `( �/
PrintName�LEJj,ti I iCL�Signature Date ���lo'��
his