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HomeMy WebLinkAbout713 Stoddard Dr - Applications/Reroof - 12/03/2014City of F\O` rt Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, 00 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). 0. Par Conditioning • Demolition (Interior non-structural) Cl Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log Q Heating Unit 0 Lawn Sprinkler © Mobile Home replacement U Roofing IZI Sewer Line M Photo -voltaic ❑ Ventilation p Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete appylications will not be accepted. Application # �11ii 2�tol (.r Date / For ofl9ce use only Job 5ite Addreas (raq~) value of Construction (labor, materials, profit) V Property Owner Name Address City/State Zip Phone c,�� 7/3Z�-� Applicant Name Address City/State Zip Phone / Contractor Address city/state Zip Phone (� Ine Contractor city of Ft. Collins Sales Tax # Are you paying taxes here or by report? 12 Here 13 Report safes er rnritAIq by ancor>iVd". Are you paying with your trust account? ❑ Yes 9 No Isthis a residential or commercial project? 13 Residential. ❑ Commercial If residential, Is It: 49 Single Family Detached © Condo/tdwnhome (single family attached) l3 Duplex E3 Multifamily (apartment) ❑ Garage If commercial, is it., ❑ Bank ❑ Bar ❑ Church 13 HoW/Motel O Medical 'office Cl Office ❑ Retail 0 Restaurant C] Other (explain) Is this building 50 years of age or more? ❑ Yes JONd if yes, you mayneed to =tact HWmic Preseivatlon If this Is for a demolition permit, what year was, the building constructed? Ifpn& to 1975, you will need an asbesAos asseasment to submit with this applfwtion. 7-A *If lawn sprinkler/backfiow preventer, must listlicensed plumber. If first-time A/C, must fist licensed elecuidan. Subcontractorm .List the company name or Oty of Ft Coffins Item 0 Sectridan Plumber Mechanical Roofer r [ l� ether. 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. x know that a permit is not valid until it has been paid and issued. , 'P�' Na ec 2M lJ' //,%�;- Signaatre baite w/