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HomeMy WebLinkAbout5314 Corbett Dr - Applications/Reroof - 04/06/201504-06-'15 15:19 FROM -Premier Roofing of F®rt Collins 9704848308 T-306 P0005/0006 F-602 Planning, Development & Transportation 281 N. College Ave P.O. Box 560 Fort Collins, CD OD524 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 Air Conditioning ❑ Demolition (interior non-structural) 13 Electrical Alteration (not service change) © Gas Lighter ❑ Gas Log 0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement YRoofing r Sewer Line ❑ Photo -voltaic I] Ventilation 0 Water Heater ❑ Water Line 0 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 # 0 J S O For 07m use only Job Site Address Property Owner Name �- Annlicant Name Contractor or. Address I nS Address +Ito Address Date Value of Construction (labor, materials, profit) City/state Zip Phone p40w oo-8< City/state Zip Phone City/State Zip Phone Contractor City of Ft. C011insAales Tax # AAlou paying taxes here or by report? Here ❑ Report SYlestaxnumber Ismqukedbyall contractors. Are you paying with your trust account? 0 Yes 0 No Is this a residential or cogmmercial project? "Q&Residential 0 Commercial If residential, is it: )&Single Family Detached ❑ Condo/townhome (single family attached) 13 Duplex 0 Multifamily (apartment) 13 Garage If commercial, Is it: 0 Bank ❑ Bar 0 Church 17 Hotel/Motel ❑ Medical office 0 Office ❑ Retail a Restaurant 0 Other (explain) Is this building 5o years of age or more? 13 Yes )QNo Ifyes, youmayneedto cnntactHistodcPreselvatfon If this is for a demolition permit, what year was the building constructed? Kprlor to 1975, you wiz/need an asbestos assessment to submit with this application. *If lawn sprinkler/backnow, preventer, must list licensed plumber, If first-time A/C, must list licensed electrician. Subcontractorsi ListthecompanynameorLYtyofFtCollins/lCenm# Electrician . Piumber� 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. �'11 ' I ^ Applicant: { 0q `dl_!1 Print Name;� r rYi1(10 Signature Date i 3