HomeMy WebLinkAbout4404 Monte Carlo Pl - Applications/Reroof - 03/18/2015City
of � C���f�tl sr� planning, Development & Transportation
281 N. CoAve
F6 6 s Fort Co I nls, CO 80524 P.O. Box 580
Phone 970-416-2740 Fax 224-6134
OVER-THE-00UNTER 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 s ice 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 # :B � 45c) , g�
For,office use only
Date , I- R:z J
Job Site Address (required)
Value of Construction (labor, materials, p/ fit)
Property Owner Name Address
City/State Zip
Phone / Zc�
1
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Applicant Name bGuil-vetY (ICe Address
City/State Zip
Phone
Contractor Address
x
City/State Zip
Phone
�L l-eu1te-i
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
Sales tax number isrequiredbyall contractors.
Are you paying with your trust account?
❑ Yes N0
Is -this a residential o� commercial project? \" Residential ❑ Commercial
If residential, is it: mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
'❑ Multifamily (apartment) ❑ Garage
If commercial, is it: k❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50years of age or more? ❑ Yeso /fyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was tPre building constructed?
lfpr/or to 7975, you wi//need an asbestos assessment to submit with this application.
Description of
S o t�
*If la% rAprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
i
Subcontractors: List'the company name or City of Ft Collins license #
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. 1 know that a
permit is not valid until it has been paid and issued.
Applicant: "/�
Print Nam,"Pa � t�/� signature Date