HomeMy WebLinkAbout4868 Innovation Dr - Applications/Reroof - 03/26/2015Planning, Development & Transportation
City! of 281 N. College Ave P.O. Box 580
Flirt CoW ns Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-TH &COUNTER PERMITS ONLY
This application is to be used to apply for the following permits onl check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not sere a change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacementt 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.
Application #
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required)
Value of Construction Dbor, 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
Contractor
Address City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required by allconrractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential 19'Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) , ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ ylai
I/Motel El Medical office ❑ Office ❑ Retail
❑ Restaurant El Other (exp
Is this building 50 years of age or more? ❑ Yes 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.
Description of
0_1/ r
A -
*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 #
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: PrintP< e(70 �J
(Name: Signature
Date