HomeMy WebLinkAbout2921 Timberwood Dr - Applications/Reroof - 04/22/2015 (18)c['a v o
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Ppanning, Deveiopment Bi Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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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_infor. ation heDa pliaation. Incomplete applications will not be accepted.
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For office use only
Sob Site Address (required)
Vague of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip Phone
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Applicant Name
Address City/State Zip Phone
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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
Saiestax number isrequired 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
'Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank 11 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes fJ 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 will need an asbestos assessment to submit with this application.
Description of work Ec Z-IIl lr �� ✓ZF7J� � le— /¢�`/,�[//�,� —S-/-�&5
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: ListthecompanynameorCityofFtCollinslicense#
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: _ �7`////
Print Name:x` y/*\Ill' FW/ signature ��l /��Lr/�-t _�� Date