HomeMy WebLinkAbout413 Skysail Ln - Applications/Reroof - 09/03/2014Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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 se ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement AlRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). d
Complete all applicable
, rinformation on the application. Incomplete applications will not be accepted.
Application # N1 _D750 �- DateT 3 /y
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
l LAJ61oM
13 sN
Property Owner Name
Address
City/State Zip
Phone
ae
Applicant Name
Address
City/State Zip
Phone
Contractor
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 isrequ/red by allmnftactors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or�cpmmercial project? VResidential ❑ Commercial
If residential, is it: K 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 (explain)
Is this building 50 years of age or more? ❑ Yes X No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? AIA
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*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- A Plumber_ Mechanical / 1 Roofer:701 r t 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: //�� �j q
Print Name:C MA%;e, Signature / Date / 20%