HomeMy WebLinkAbout4901 Ninebark Ct - Applications/Reroof - 10/30/2014City o� Planning;,Development &Transportation
Foy 281 N. College Ave P.O. Box 580
rt Collins Fort Collins, CO 80524
Phone 970-4.16-2740 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 # F I"( I I �d, k Date C) 30'7
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
C 1L-
Property Owner Name Address
City/State Zip
Phone
CrYSr/�
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
-to2o
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
fkHere ❑ Report
sales tax number is required by all cantractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? MResidential ❑ Commercial'
If residential, is it: EkSingle 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 J&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.
Description of work
*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 RooferP-� V,[
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: V _fiJk\ -Signature /if/ �&_264
Print Name: '�.li`i�"-t � ` lS nature � � fDate