HomeMy WebLinkAbout5801 Ballina Ct - Applications/Reroof - 08/30/2014City Of Planning, Development &Transportation
ft Collins 281 N. College Ave P.O. Box 580
F6
Fort Collins, CO 8
Phone 970-41616-2740740 fax 224-6134
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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 Stove (must. be EPA certified, provide make, model and
manufacturer). i
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 2Oq• Date
For offIce use only
Job Site Address (re wired)
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Value of Construction (labor, materials, profit)
Pro ertylI Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Colli s Sa es Tax #,�[��
Sales tax number is required by all contractors. Are you paying with your trust, account?
g0877
Les ❑ No
Is this a residential or commercial project? >6 Residential ❑ Commercial
If residential, is it: Zsingle 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 XNo 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
*If lawn sprinkler/back-flow preventer, must list licensed plumber. If first-time A/C, must list
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.
Applicant: \ � 1 1 1
Print Name: 0 h
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