HomeMy WebLinkAbout4513 Seaboard Ln - Applications/Reroof - 09/25/2014Planning, Development,&Transportation
City Of 281 N. College Ave P.O. Box 580
Flirt 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 ❑ 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 # ?A 141`�QUS Date 9 �2 /7
For office use only
)ob Site Address (required')
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
City/State. Zip Phone
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Contractor
City/State Zip Phone
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pAddress
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? EV Here ❑ Report
Sales taxnum Is by allcon&actors:
Are you paying with your trust account? ❑ Yes 11 No
Is this a residential or:commercial project?" ® Residential ❑ Commercial
If residential, isit: 49 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes lib No If yes,.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.
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Description of work
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license x
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.
Print Name: l/11 Signature