HomeMy WebLinkAbout3319 Oregon Trl - Applications/Reroof - 07/20/2012Fort 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 ErAoofing ❑ 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 wii I not bez
accepted.
Application # ��Z Date 7/ 12--
For office use only 1 rn n
Job Site Address (required) Value of Construction (labor, materials, profit)
3311 ore (r-aj $ Z,S =p
Property Owner Name Address
City/State
Zip
Phone
N.rc -,I- I
vre. 'Te6-14�I
POSz6
-5Z) —673?
Applicant Name Address
City/State
Zip
Phone
C s 4 n•� a S 9 ovt
Contractor Uc # Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or co ercial project? EMesidential ❑ Commercial
If residential, is it: RSingle 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 ONo 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 work
ZS 5
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician:
Subcontractors: Listthe 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: 1' -
Print Name: r` ` a 1 ` Signature _Date