HomeMy WebLinkAbout5223 Paradise Ln - Applications/Reroof - 10/14/2014Planning, Development & Transportation
City of 281Fort Collins For N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740 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.
Application # 151 A-1 I I &La .
For offce use only
Incomplete applications
will not be accepted.
Date /oz/q
Job Site Address (required)
Value of Construction (labor, materials, profit)
6223 Pcro_J, gas'
00
Property Owner Name Address
City/State Zip
Phone
ft6 Z20 Pad '
l kb s co &0Q
Q 7o &5-o6Yl
Ap icant Name Address
City/State Zip
Phone
1 v I Pham,
V-5-90-3799
Contractor Address
City/State Zip
Phone
1 iion 73.53'
nd ln/i njw co
S SY
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here 1 ❑ Report
Sales tax number is required by allcantractors
Are you paying with your trust account?
Yes ❑ No
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? j<Residential ❑ Commercial
Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )KNo Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
of work KP —
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician
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: Peixra
Signature Date ( r