HomeMy WebLinkAbout2921 Timberwood Dr - Applications/Reroof - 04/22/2015 (9)citv Of Planning, Development & Transportation
{, [� ��i 281 N. College Ave P.O. Box 580
CoH u Its Fort Collins,. CO 80524
Phone 970-416-2740 Fax 224-6134
OVER—THE—COUNTER PERMITSONLY
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 a plli ation
no
Application #
Fo be,E6 use only`
Incomplete applications will not be accepted.
Date '-1lz*t'
Job Site Address (required)
Vallue of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
L� C=-A( c`=iaR,44 1 (2610 IVCD -71610
Contractor Address
City/State Zip
Phone
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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 byall contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
'EiNuldfamily (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 X No If yes, you may need to contact HistoricPreseruation
If this is for a demolition permit, what year was the building constructed? _
If prior to 1975, you wit/ need an asbestos assessment to submit with
Description of work
this application.
wo
e u r 2E 4f i , -'-c:.> lY=_� ; . der Tn��/
*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
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: �����/`� (=7�(% Signature _��J/ Date ZZ