HomeMy WebLinkAbout4808 Chippendale Dr - Applications/Reroof - 06/16/2015Cityof Planning, Development & Transportation
{ /� (� 281 N. College Ave P.O. Box 580
F® �_ r` Collins ! 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not se ice change) El Gas Lighter ❑ Gas Log
❑ Heating Unit El Lawn Sprinkler ❑ Mobile Home replacement I 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. Incomplete applications will not be accepted.
Application # 9�( 5U KS -JS
For olbce use only
Date (aA A
Sob Site Address (required)
Value of Construction (labor, materials, profit)
96 $ h'PID DAL lZ
37ao
Property Owner Name Address
City/State Zip
Phone
roNAf D t&&s A0 c[tos o/9. Fr- 6Li-Y"f 86 9
rho-w-2_-36,o-1
Applicant Name Address
City/State Zip
Phone
Q"i zl 4.t6.,_ D#?,
r &L1,z1-f 6 (?QJ_ aS-
97d-2,00-6f9V
Contractor Address
City/State Zip
Phone
rn S o ScdEN LA 1
de- v d C) ees?g
q-X-6&3-f6,v
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 co mercial project? Residential ❑ Commercial
If residential, is it: KSingle 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 If yes, you may need to contact HistorkPreservation
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.
scription of work
n _
lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber
Mechanical Roofer
C
aan. S?' W
&tS it 0%n,00/0
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: Pi-o'lJ Oy'so N Signature Date