HomeMy WebLinkAbout5101 S Shields St - Applications/Reroof - 09/05/2014Sep 09 1410:17a Tony
1-970-669-5999 p.2
City of Planning, Development & Transportation
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281 N. College Ave P.O. Box 580
, 6r} ` Colfi1 i1S Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
*I
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 El 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 # S 14-1)$3P+2,, Date _
For office use only
Job Site Address (required)
Value of Cqrlstruction (labor, materials, profrt)
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Pr erty Owner Name Address
City/State Zip
Phone
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Applicant Flame Address
City/State Zip
Phone
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Contractor Address
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City/State Zip
Q 0-�p��- 99
Phone
Contractor City of Ft. Collins Sales Tax #
Safes tax number isregwredbyall contractors
Are you paying with your trust account? ❑ Yes
Is this a residential or commercial project? _-AMesidentlal ❑ Commercial
If residentia, is it: 40ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) I] Garage
If commercial, is it ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yas ❑ No If yes, you may need to con a Historic Preservaf*on
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
of work
lawn spiJinider/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or 0,)V of Ft Collins license'-
-Electrician Plumber Mechanical Roo`er ® 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.
Applii
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