HomeMy WebLinkAbout5238 Apple Dr - Applications/Reroof - 09/04/2014of
�F®r 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 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 # '&140 144,te, Date `7` �� ` Zo/q
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property OwnerName Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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V 1) a v- 3 -73
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? IkResidential ❑ Commercial
If residential, is it: Asingle 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 ❑ No Ifyes, you mayneed to contactHistoricPreservation
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
lawn sp ennklennkl r/backflow preven`ter, 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:
Print Name:. prG2 %�/il� Signature
Date T 7 - z�z