HomeMy WebLinkAbout1209 Sawtooth Oak Ct - Applications/Reroof - 10/03/2014City f Planning, Development & Transportation
6FY O281 N. College Ave P.O. Box 580
_rt Collins 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 Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 6Iy ) 051 �)
For office use only
Date lob / 1 y
Sob Site Address (required)
Value of Construction (labor, materials, profit)
20 a"V-tO
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Property Owner Name
Address
City/State Zip Phone 970-6c1
Z09
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Applicant Name
Address
City/State Zip Phone
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gi7o-590-3798
Contractor
Address
City/State Zip Phone
i +oa.
35-5-
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?Here ❑ Report
Sales tar number& required by a//contractors.
Are you paying with your trust account? ❑ Yes .XNo
Is this a residential or commercial project? 9 Residential ❑ Commercial
If residential, is it: gSingle 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,oncr 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-bme A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license F
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:
Print Name:l Signature DateNA-3h 'I
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