HomeMy WebLinkAbout1355 Iva Ct - Applications/Reroof - 11/03/2014Nov 041412:02p Tony
1-970.669-5999, p.4
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CD 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 # 61` t[q53
For office use only
Date ! j ley
Job Site Address (reouired)
1355
Value of Co struction (labor, materials, profit)
I
Property Owner Name Address
City/State
Zip
Phone
fflarr a
-C
d - SI
A plicant Name Address
Gty/State
Zip
Phone
h rA L
v and!
6
- 4q
ntractor Address
hrIL
City/State
Zip
Phone
12007610
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o
Contracbor City of Ft. Collins SalesTa
Safes tax numserisrequired byall con Gictom
Are you paying with your trust account? ❑ Yes Y40
Is this a residential orMS11ultifarrilly
mercial project? LKesidential ❑ Commercial —�
If residential, is it: ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
(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 cvnfactHistoric Presen2tion
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
of work
lawn sprinkler/bacldiow preventer, must list licensed plumbers If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty 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
compiy 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: Signa ate