HomeMy WebLinkAbout1406 Ticonderoga Dr - Applications/Reroof - 11/05/2014Cit . of 281 N' College Ave p P.O. Box 580sportation
FOr` ColtinS 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 se ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement se
❑ 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 # S14114{p3.
For ofltce use only
Incomplete applications will not be accepted.
Date n /5 -/W
Sob Site Address (required)
Value of nstruction (labor, materials, profit)
Properly Owner NameLi, Address
City/State Zip
Phone
04
61 c
970
Applicant Nam A dress
VePLi
City/State Zip
P one
?;nt actor Address
City/State Zip
Phone
2LIZ / d
Contractor City of Ft. Co tins Sales Tax #
Are you paying taxes here or by report?
❑ Here WReport
Sales tax number is requiredby //contractors.
Are you paying with your trust account?
❑ Yes No No
Is this a residential or cqmmerclal project? )K Residential ❑ Commercial
If residential, is it: JQ 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 XNo Ifyes, you may need to contact H/stoncPreseruation
If this is for a demolition permit, what year was the building constructed?
Ifjonor to 1975, you will need an asbestos assessment to submit with this application.
of
*If lawn 4prin0er/backflow preventeF,- must list'icensed plu(666. dfirst-time A/c, m4list 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: � �
Print Name:
Slgnatu 4�-�i�