HomeMy WebLinkAbout951 Nightingale Dr - Applications/Reroof - 09/10/2014Fort of
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 Sto4e (must be EPA certified, provide make, model and
manufacturer).
Complete aM'a li 16 I(o a !on
can t� application. Incomplete applications will not be accepted.
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Application Date 1110 fil
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner game V
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
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City/State Zip
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Contractor City of Ff. Collins Saldrax
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Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number isrequIredbyall contractors
Are you paying with your trust account? ?O%es ❑ No
Is this a residential o mercial project? Residential ElCommercial
If residential, is it: )Com
Ingle Family Detach d ❑ 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 SO,years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is fora demolition permit, .what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacldlow 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
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.
Print Name: Signature Date beh
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