HomeMy WebLinkAbout1400 Centennial Rd - Applications/Reroof - 05/18/2015May 18 1508:34a
p.1
:Collins
Planning, 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 appli ation 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
❑ Ventilati n ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete III applicable information on the application.
# -P�>l .
For offce use Only
Incomplete applications will not be accepted.
Date s-// p
Job Site,
dress (required)
Value of Construction (labor, materials, profit)
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Address
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City/State Zip
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Phone
Contractorl
City of Ft. Collins Sales
Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Salestaxnurhb:risrequ-redbyal,'contractors.
Are you paying with your trust account? XYes ❑ No
D �
is this a n
if resident
If commei
Is this bui
If this is fi
If prior to
Descript
*If lawn s
dential or commercial project? 39 Residential ❑ Commercial
is it: XSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
if, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel!Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
ng 50 years of age or more? ❑ Yes X No If yes, you may need to contact Historic Preservation
a demolition permit, what year was the building constructed?
975, you cvlll need an asbestos assessment to submit with this application.
of work
rn
be—
kler/bachflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
List the company name or City of Ft Collins license #
Plumber Mechanical Roofer
other
I hereby 1knowledge that I have read this application and state that the above information Is complete and correct. I agree to
comply wall requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit iotvalid until it has been paid and issued. /J
Applican� �t S
Print Na
_e; t) Y1 es Signature