HomeMy WebLinkAbout2404 Crabtree Dr - Applications/Reroof - 11/12/2015City o$ Planning, Development & Transportation
or N. College Ave P.O. Box 580
F®rt CollinsC�s Fort Collins, CO 824
Phone 970-416-274740 Fax 224-6134
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 KRoofing ❑ 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 # Date I / /Z / t
For ofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit) :'7�
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Property Owner Name
Address
City/State Zip
Phone
Applicant Name R&__ .F
Address
City/State Zip
Phone
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Contractors
Address
City/State Zipn
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 by all contractors.
Are you paying with your trust account? ❑ Yes g No
Is this a residential or commercial project? *Residential ❑ Commercial
If residential, is it: O-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 If yes, 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 K,E?06,= w)�i 62 jt.MRc.oLr.yL 1kP-1:f77_ CTtVf/
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*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 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: eljklS
Print Name: Signature Date f l l f