HomeMy WebLinkAbout4591 Seaboard Ln - Applications/Reroof - 12/11/2014Planning, Development & Transportation
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 0 Mobile Home replacement # Roofing 0 Sewer Line D Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water line ElWood/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 # 2v l Date
ror office use only
Job Site Address (rmullvd)
Property Owd,er Name Address
Applicant Name
Contractor
Contractor City of R. Collins Sales Tax #
Sales tax number is mqulred try ad contractors.
Value of Construction (labor, materials, profit)
City/State + Zip Phone
ZIp Phone
City/state /Zip Phone .(?03)
k Wt ff�/G 1,,�►'lbrnh-r:jl� , d)2b $S4.
Are you paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? D Yes ❑ No
Is this a residential or commercial project? Y Residential ❑ Commercial .
If residential, is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
M Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office L3 Retail
❑ Restaurant 0 Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No Ifyes, 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 with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/st One rompany name or CrtyafFt Collins license
Electrician Plumber. Mechanical Roofer J sK
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 i8 not valid until it has been paid and Issued.
Applicant. 1,t
Print Name: ka. V f`�>ri SignatureQJ�1 Date
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