HomeMy WebLinkAbout4330 Arcada Ct - Applications/Reroof - 07/25/2014.Tul.16.E01$ 12a34 rM
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Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 97D-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). Cl Air Conditioning.
C7 Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application #
For o i� use only
Incomplete applications will not be acce. ad.
Date J U-I I I� I aR A f 4
Job Site Address (required)
Value of Construction (labor, materials, profit)
o
3;;L�
Property Owner Name Address
City/State Zip
Phone
3- r'
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Appli nt Name Address
City/State Zip
Phone
�a
719.
7
Contractor Address
City/State Zip
7/Phone.
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D
, 17
Contractor City of 14. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here Report
sales7axnul�rrrequrr�allcvnrraca��s.
Are you paying with your trust account?
Ct Yes o
b
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 (expMIqn)
Is this building 50 years of age or more? O Yes rn No if yes, you may need to coniactH/stor/c Presetvatlon
If ails Is for a demolition permit, what year was the building constructed?
Ifpdor to 19iS, you will need an asbestos assesgnant to submit with this applIcabon.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/st the company name or City cfftCollins Ikense #
EkEtrkian Plumber Mechanical
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.
Appllcarrt:,�7� 1
Print Name:....Ud ,a 1, Signature Date _