HomeMy WebLinkAbout3002 Indigo Cir S - Applications/Reroof - 03/11/2015Cit of Planning, Development & Transportation
281 Flort Collins Fort Colns, CO 80524 P.O. Box 580
�- Phone 970-416-274o Fax 22+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. �I1
Application # LQ k� l Date
For ofce use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Colli s Sales Tax # Ar
you paying taxes here or by report?
�e ❑ Report
sales tax number is required byal/contractors. Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or com�►ercial project? [Kesidential ❑ Commercial
If residential, is it: 12Single 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 fyes, you may need to contact HistoricPreservabho
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinkler/bacldlow 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 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: - Irl l DE
Print Name:
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