HomeMy WebLinkAbout5112 Greenway Dr - Applications/Reroof - 10/31/2014City of Planning, Development & Transportation
Collins
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 ❑ SewerlLine ❑ 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 ff_�t'(� }
For office use only
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
7 ity/State Zip
Phone
�✓+�-"
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Applicant Name d
Address
City/State Zip
Phone
170-00-16
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Col s Sa es Tax
Sales tax number is required by all contractors.
gQ577
Are you paying with your trust; account?
files ❑ No
Is this a residential or commercial project? jZ] Residential ❑ Commercial
If residential, is it; ZZingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar Cl Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes CZ No If yes, you may need to contact Historic Preservation
If this is fora demolition permit, what year was the building constructed?
If prior to 197s, 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-time A/c, must list licensed electrician. 511�^S
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; 'M -
Print Name: _ O �n ►' 1 • [Aq ,4.5 Sig
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