HomeMy WebLinkAbout3443 Sun Disk Ct - Applications/Reroof - 10/07/2014Fort CoMns
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 Rooting ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation El Water Healer ❑ Water Line ❑Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # lJ� 140 991E Date 10 jr{_( l`k
For ofrce use only Ar.
Job Site Address (required)
Value of Construction (labor, materials, profit)(® -
�"~ 5�`' CovY T fit". CS Go $bSZG �26 - 6
Property Owner Name Address
City/State Zip Phone
`td.n L'orb�
��+� tots J
Applicant Name Address
City/State Zip Phone
-3 M'0 M71STr
Contractor Address
City/State Zip�g� SI
� Phone .�1*1`1
I SS ��rST' P�fa-dwA-tom l7cti
I �' � 6� � t`nt�n S �o
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? lj-1-lere ❑ Report
.Salestaxnuumbcerissrrequiredbyallcon"ctors.
0044-
Are you paying With your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? rAResidenlial ❑ Commercial
If iesidentlal, is it: Single Family Detached ❑ Condo/lownhome (single family attached) ❑ Duplex
Multifamlly (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 g No 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.
of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty ofFt Collins license #
Electrician. t�k (,fplon�hef �`�. Mechanical_KLft— Roofer_[`{(_&__ Other B(I*
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: Signature �1*z Date 14 -1 / l tp