HomeMy WebLinkAbout2612 Parklake Ct - Applications/Reroof - 04/24/20151 planning, Development &Transportation
�° Vv City Of ' A ,��\ 281 N. College Ave P.O. Box 580
F / 6rt Collins 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 # �� Date � • �)
For office, use only
Job Site Address (required) .
Value of Construction (labor, materials, profit)
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6W. (70
Property Owner Name
Address
City/State Zips Phone q-R)
Applicant Name
Address
City/State Zip Phone
Contractor —t }� 3
Address
City/State Zip Phone Q
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J.�J`LY�+? TC CD L) o;>'A _1;aco
Contractor City of Ft. Collins Sales Tax # L4 13 4 (a
Are you paying taxes here or by report? ❑ Here X Report
Sales tax number is required by all contractors
Are you paying with your trust account? 91 Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached IM 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 EDNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? & 'n
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
L
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or City of Ft Collins license # v c),,r .D_111�CZX912 �Nr l l
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.
Applicant:
Print Name: !`r Ck Signature
Date 4.
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