HomeMy WebLinkAbout512 E Monroe Dr - Applications/Reroof - 03/25/2015 (2)City of Planning, Development & Transportation
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 )1 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 #?-? t 5 b l C� q*5
For office use only
Incomplete applications will not be accepted.
Date 2�
lob Site Addre (required)
Value of Construction (labo materials, profit)
Property Owner Name
Address
City/State Zip Phone
Applicant Name a
Address
City/State Zip Phone
' 4,0.065 ISI
All Cove-
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Contractor
Address
City/State Zip Phone
Contractor City of Ft. Collins Sales
Tax #
Are you paying taxes here or by report? klHere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑Yes XNo
Is this a residential or commercial project? K Residential ❑ Commercial
If residential, is it: ❑ Single 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 If yes, you may need to contact HistoricPreservat%on
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.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: Ust the company name or City of Ft Collins license # &�7�5�
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:dJ (�
Print Name: V l Signature/e'Date !�
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