HomeMy WebLinkAbout523 Edwards St - Applications/Reroof - 11/04/2014OAF Planning, Development & Transportation
Fes} 281 N. College Ave P.O. Box 580
r VI d �O��fnS 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. Incomplete applications will not'be accepted.
Application Date
For office use only
lob Site Address (requ_ ireq)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone-
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zi
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Contractor City of Ft. Collins
4 Tax # 141 0�51j
Are you paying taxes here or by repo
ere ❑ Report
sales tax number tsrequired byall conbactom
Are you paying with your trust account?}' ❑ No
Is this a residential or com ercial project? ntial ❑ Commercial
If residential, is it: mgie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ uitifamily (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 Ifyes, you mayneed to wnfactHistoricPrese wbFon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will nee an asbestos a-wmI lent to submit with thisapplicabon
Description of work
*If lawn sprinkler/baddtow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty offtCol/ins license #
Eectridan Plumber Mechanical Roofer Other
I hereby adorowledge that I have read this application and state that the above information is complete and coned: 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: JO 6106L Signature
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