HomeMy WebLinkAbout609 Langdale Dr - Applications/Reroof - 09/27/2014Planning, Development & Transportation
City/ of 281 N. College Ave P.O. Box 580
Fort 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 # Date
For office use only
Job Site Address (requiredv ` ,
' Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
Appli ant dame Address
City/State Zip g0525Phone
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Contractor Address
City/State 'Zip Phone
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Contractor City of Ft. Col ' s Sa s Tax #
Are you paying with your trust account?/KY-esElNo
Sales tax number is required by all contractors. q0$-7-7
Is this a residential or commercial project? LY-Residential ❑ Commercial
If residential, is it: -a ingle 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 []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. 1 gam'
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of work
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*If lawn sprinkler/backflow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Co 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: L ,,/► (�
Print Nam "' J" kLs iio—Signature
Date 9 - /
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