HomeMy WebLinkAbout820 Merganser Dr - Applications/Reroof - 04/22/2015 (13)Planning, Development Ut Transportation
I, �€ ° ° 281 N. College Ave P.O. Box 580
/ ,�-6rt C&h IIS 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). O 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
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the applica�lt on.
Application
�" Foy office use only
Incomplete applications will not be accepted.
Date t-) Lz-2- t:2;-
.fob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
Applicant Name
Address
City/State Zip Phone
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Contractor
Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by allcontractom
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
AMultifamily (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 mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wilt need an asbestos assessment to submit with this application.
Description of work
7
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*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: ListthecompanynameorCity ofFtCollins license #
Electrician Plumber Mechan
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: 2 ,/ /
Print Name: �,2yi9�j Signature s c� �— Date L ZZ (�