HomeMy WebLinkAbout440 Circle Dr - Applications/Reroof - 02/09/2016 (2)Feb 091612:00p Tony
1-970-669-5999 p.1
ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 FaX 224-6134
O"VER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing D Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater Cl Water Line ❑ Wood/Pellet Stove (must be EPA certified provide make, model and
manufacturer).
Complete all applicable ,ninformatiionnon the application. Incomplete applications will not be accepted.
Application #_ I U 0OU ItDate , 0401(o
For office use only
Job Site Address (required)_
Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State Zip Phone
Applicant Name
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Phone
Address . City State AvldjC�
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Contraccttor, ,
Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Sales ta7rnumberisregoiredbyall contradors.
Are you paying with your trust account?XYes p No
Is this a residential or commercial project? 23 Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerdal, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office Ll Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years OF age or more? ❑ Yes XNo ifyes, you may need to contactHlstoncpreservafmn
If this is for a demolition permit, what year was the building constructed? ,
ff prior to 1975, you will need an asbestos assessment to submit witti this appllcatfan.
Description,pf work
*If lawn sprinkler/baddiaw 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 it
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
comphf 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: Sig aiure Date C-&)