HomeMy WebLinkAbout4106 Clayton Ct - Applications/Reroof - 01/29/2015City of Planning, Development & Transportation
Fy} 281 N. College Ave P.O. Box 580
or` 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 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 application. Incomplete applications will not be accepted.
Application # 6I501)SS4b Date b-d-g-LS
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
SINS SOS;S I S Dn D
Property Owner Name��77 Address City/State Zip Phone
LLB -� PLA-1p `�I(X G�j `r�ivti LI J � [ 5
Applicant Name Address City/State Zip Phone
�P03 Aq-T,7 D/L f_ 501 �OSvS
Contractor �j f n Address City/State Zip Phone
05 !� qor 7 u&- �1 I(L�� i �- l ! ! ` l S'SS -SS ['rrlcs
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? VPYes ❑ No
Is this a residential or commercial project? t,2Residential ❑ Commercial
If residential, is it: mingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Ql�No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of
L` J:" GR
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer
Other
SYczt'z.O
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. /7
Applicant:
Print Name:Az Signature
Date C7`/ l