HomeMy WebLinkAbout820 Merganser Dr - Applications/Reroof - 04/22/2015 (12)r Planning, Development Ut Transportation
�i tf11� ° ��i 281 N. College Ave P.O. Box 580
(
OR S Fort Collins, CO 80524
f Phone 970-416-2740 Fax 224-6134
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 ❑ 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
Application
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Incomplete applications will not be accepted.
Date _Li Lzz_6-
Job Site Address (required)
V9all ue of Constructlon (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
1q,t/0476W�
700
Contractor
Address
City/State Zip
Phone
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7/00
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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?
❑ 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 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contactHistoric 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 workF�'�'/�iG%'
*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
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:
Print Name: �i�i�jitO�I Jp`�(� �( Signature 4_- Date zyzz-z