HomeMy WebLinkAbout3208 Yellowstone Cir - Applications/Reroof - 10/08/2014_ — Planning, Development & Transportation
FOrt Collins 281 N. College Ave P.O. Box 580
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 ❑ 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 # J&40%#14P Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State
Zip
Phone
'i1 Ot, t-:-uJ '2.)20% ibi`e
'r%mLtiwa
&671
L11- L41
Appli��c��annrrt Name Address
City/State
Zip
Phone%
p ^
(05
1 33
Contractor Address
City/State
Zip
Phone
Z17S5. yw4.OWIA
�Lum9
t11
3-bclb- 3°177
Contractor City of Ft. Collins Sales Tax #
5alestax number isrequired byall contactors.
Are you paying with your trust account?
❑ Yes No
Is this a residential or com erdal project? 0
If residential, is it: Single Family Detached
❑ Multifamily (apartment)
sidential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 Histodc 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 wide this application
Description of work
*If lawn sprinkler/bacldtow preventer, must list licensed plumber. If first-time MC, must list licensed electrician.
Subcontractors: Ust the comP30y name or city of Ft Collins license #
e
Electrician Plumber Mechanical Roofer4L- 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: 1, �>
Print Name: art Signature �=O/ Date (� b