HomeMy WebLinkAbout708 Garfield St - Applications/Reroof - 07/10/2015City,of Planning, Development&Transportation
281 N. College Ave P.O. Box 580
�Cottin5 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 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. Incomplete applications will not be accepted.
Application # 51 S0 SN 3 Date _ -7 r ! 6
For office use only
Job Site Address (required)
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Value of Construction (labor, materials, rofit)
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Property Owner Name Address
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",� City/slate Zip Phone_Aq
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ApplicAnt Name Address
City/State Zip Phone
Contractor Address
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City/State Zip / Phone
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Contractor City of Ft. Collins Tax #
Sa/fstax number isrequired byall contractors.
Are you paying taxes here or by report? Here ❑,Report
Are you paying with your trust account? ❑ Yes o
Is this a residential
If residential, Is it:
or o mercial project? C
mgle Family Detached
Multifamily (apartment)
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 mayneed 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
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time 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 Nan Signature Ney I ` 10�� Date
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