HomeMy WebLinkAbout2731 Sagebrush Dr - Applications/Reroof - 04/20/2015City ®f
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 # V �� a �� Date 4X. 13
For office use only
Job Site address (required)
Value of Construction (labor, materials, profit)
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Pro erty Owner Na a Address
City/State Zip
Phone
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Ap ican Name Address
City/State Zip
Phone
ontra r Addres
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?ere ❑ Report
sales lax number is required by all contractors.
Are you paying with your trust account?
❑ Yes E_1_;
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: Single Family DetaclVd ❑ 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 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was t4building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
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` *If lawn sprinkler/bac ow preventer, must list licensed plumber. hf fi st-time A/C, must list 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.
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