HomeMy WebLinkAbout2624 Raintree Dr - Applications/Reroof - 04/16/2015Planning, Development & Transportation
OOT..��_ ®�}` O'��®�O` i�� 281 N. College Ave P.O. Box 580
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 .9 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 a pli_a lion.
AN'llcatl�n�
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Incomplete applications will not be accepted.
Date
lob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
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Ci /State
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Zip
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Phone
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Applicant Name
Address
City/State
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Zip
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Phone
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Contractor (�
Address City/State
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Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number isrequired by all contractois.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ 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 this building 5o years of age or more? ❑ Yes 12I No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you Ivlll need an asbestos assessment to submit with this application.
*If lawn sprinkler/bacidiow preventer, must list licensed plumber. If first-time A/c, must iisc ucensea eiecmoan.
Subcontractors: L&Me company name or City ofRColl/ns Acense #
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: pp
Print Name: W a/N ' �o 1 z/ Signature Date `� �� �o �S