HomeMy WebLinkAbout512 Sundance Ct - Applications/Reroof - 11/13/2014City Of Planning, Development & Transportation
{� 281 N. College Ave P.O. Box 580
F6rt
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 Aloofing ❑ 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.
Application # 'Ia,1441-1119
For of Ice use only
Incomplete applications will not[ be accepted.
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
$
Owner Name
Address
City/State
Zip
Phone
7,Ppe
e do
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52sa-S /�316.57
Applicant N e
Address
City/State
Zip
Phone
Contractor Uc # $
Y'
1�i83 Address
City/State
Zip
Phone CiiG'
�J
2, Li
C,
Co 502?- 1
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Contractor City of Ft. Collins Sales Tax # t ' C p
Are you paying taxes
here or by report? ❑ Here
$ Report
Sales tar number& required by all contractors
Are you paying with your trust account? fid Yes
❑ No
Is this a residential oyoommercial project? dential ❑ Commercial
If residential, is it:ngle Family Deta ❑ Condo/townhome (single family attached) ElDuplexultifamily (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 the building constructed?
Ifpnor to 1975,, you will need an asbestos assessment to submit wfffi this application. r
of work
hlrof-P<�I , I
*If lawn sprinkler/backflow, preventer, must list licensed plumber. If first-time A/C, must list licensed el clan.
Subcontractors: List the company name or Gty of Ft Collins license # L4gu� �:�t7 0-/ j 1�
Electrician Plumber Mechanical �/ Roofer Other
I hereby acknowledge that I have read this application and slate 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 beeri paid and issued.
Applicant: -�
Print Dame: Signature
Date
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