HomeMy WebLinkAbout3507 Plumstone Pl - Applications/Reroof - 03/19/2015City of
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 0 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 #__ �� c� 1CP C5 Date Aec_ _�GI
For office use only
Job Site Address (required)
Value of Constr ction (labor, materials
fit)
350� ,� I
l
Property Owner Name Address
City/State Zip
Phone
�7-[CiA _ _) 1 R
rr-P of .vs CC) aD595
iy-968g
Applicant Name Address
City/State Zip
Phone
4tj/� S , l t aS 7cf q 3 S/utxv
L 1. P/ CcL�511z es 6 v 0':)168 7,b383 6'7go
Contractor Address
City/State Zip
Phone
W�l^ co��N 588
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? 10 Residential ❑ Commercial
If residential, is it: IM Single 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 IN No lfyes, 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.
Description of work .4 woock_
a ,cJ e _20vs ��c� rrof i A l c-Gl —
*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 if
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:4r 6 �Jor'k2s Signature 1. ate4 GUt�