HomeMy WebLinkAbout820 Merganser Dr - Applications/Reroof - 04/22/2015 (23)�� P Pganning, Development 8t Transpurtatgon
'. —� i cif ��,� 281 N. College Ave P.O. Box, 580
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—Q '*�o���Il s Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER NE -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 ❑ 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 -in ormation on the application
Application #_JJ
For office use only --
Incomplete applications will not be accepted.
Date
.bob Site Address (required)
Vague of Construction (labor, materials, profit)
D02 --er?T O.,a mjS
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Property Owner Name Address
City/State Zip
Phone
/fc C -_24MtZ R&'K 21), P 6e:Ailx AZ
6-CL—Z/7(f-35S5-
Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone
>12/llfvin(el97L6
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? LSResidential ❑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 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 work
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*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City ofFt Collins license #
Electrician Plumber Mechanical Roofer 8W1441111V 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( Jf �( ( Date
Signature t�� // i'
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