HomeMy WebLinkAbout6827 Avondale Rd - Applications/Reroof - 07/18/2012Fort 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.
Application # V5� 0
For ofce use only
Job Site Address (required)
Incomplete applications will not be accepted.
Date
Value of Construction (labor, materials,
Property Owner Name Address
City/State Zip
Phone
0o
'R-Cnkkinca 80525 c170-5510-01323.
Applicant lame Address
City/State Zip
Phone
h1 -
20.38 O
Contractor Lic # Address
'i ►ocJhy �rrEacn q
City/State LJ Zip
Phone
.
Contractor City of Ft. ollins Sales Tax #
Are you paying taxes here or by report? XHere
❑ Report
Sales tar number is required by all contractors
Are you paying with your trust account? ❑ Yes
X'No
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? XResidential ❑ Commercial
j(Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes g No If yes, you may need 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 • •mil mucS k I - r
�\ •
*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 '9\- IVA 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:Ckl-c%tmru'Q 3aCObS
Date FS 19—