HomeMy WebLinkAbout1612 Sudbury Ct - Applications/Reroof - 11/24/2014City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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�f 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 # .1'7-D`l1 . Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
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Applicant Name 1 Address
City/State Zip Phone
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Contractor Address
City/State Zip
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? V Here ❑ Report
sales tax number is required by a//mnfacmrs
Are you paying with your trust account? Id -Yes ❑ No
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: ff�Single Family Detached ❑ 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 thistuilding-SOyears-of-age-or mote?- ❑ Yes IrNO Ifyes, you may need to contact HistoricPreseruation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you w///need an asbestos assessment to submit with this application.
of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname orC/IyofItCollins //cane 9
Electridan 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
pennit is not valid until it has been paid and issued.
Applicant: �l /�
Print Name:_ i' Signature Date