HomeMy WebLinkAbout3800 Benthaven St - Applications/Reroof - 09/05/2014Sep 0514 07:10p
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Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.D. Box 580
Fort CO"ins, CC 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 CendiNoning
❑ DernoliCon (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heatino Unit ❑ Lawn Sprinkler ❑ Mobile Horre replacement ❑ Roofing ❑ Sewer?Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water Lire ❑ `Nood/Pellei Stove (must be EPA. certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #r I 1 zj0!j
For office use only
Job Site Address ,:,equired)
Date q'SI1�
Value of Construction (labor, materials, profit) zwo
Property Cwner Name
jl-�(,�tr
Address
City/state
;Zip Pfmne
Applicant m
Address
City/State
Zip Pf one
Contractor
Address
City/State
Zip Phone
Contractor C y of Ft. Coll,
s Sa es Tax
sales taxnumber&required bvallCont.-actors. �l
Are you paying with your trust.
account? E*Yes ❑ No
I Is this a resieentlal or commercial project? 1,6 Residential ❑ Commercial
I residential, is it; .l-.single Family Detached ❑ Condc/:ownhome (single family attached) ❑ Duplex
❑ Mdti`amily (aparment) ❑ Garage
-if curnmercla., is it: ❑ Bank ❑ Sar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Ot lar (explain)
is this building 50 years of age or more? ❑ Yes IXNo If yes, you may need to contact Historic Preservation
ii this is fora demolition permit, what year was the building constructed?
If error to I9, S, you will need an asbestos assessment to submit with &ris application.
Description of work
*If'Otin sprinkler/baclalow preventer, must list licensed plumber. If first-time AJC, must list licensed electrician. S,
Subcontractors; List the company name or Gty of Ft Collins Ai erse
Electrician Piurr:ber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. r agree to
comply with ail requirements contained herein and city ordinances and state laws regulating b;;ilding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant; }1- ,�/►
Print Name:�0 "h V ► I • �8 1-�rj 5ignatu to r (`�