HomeMy WebLinkAbout2836 Adobe Dr - Applications/Reroof - 05/09/20165/5/2016 12:01 PM FROM: 9702081701
TO: +19702246134 P. 1
FCity of
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER -TIDE -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 0 Lawn Sprinkler ❑ Mobile Home replacemen2<e(must
Roofing 0 Sewer Line 0 Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Pellet S be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # T✓ �(� OoZ `� ��` _--- Date —_-- _ ---5
For office use only
Job Site Address (required)
Value of Construct -ion (labor, materials, profit)
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Propierrty Owner Name Address
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Cit`y�/State ( jl Zip
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Phone
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Applicant Name Address
City/State Zip
Phone
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>Uere ❑ Report
.Shies tax number is required by contractors.
Are you paying with your trust account r , 'Yes
❑ No
Is this a. residential or commercial project? Residential ❑ Commercial
If residential, is it: PeSingle Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) O 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 ZNo If yes, you may need to contact Historic Presetvation
If this is for a demolition permit, what year was the building constructed? VJ11 Py
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If 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 # Mechanical_ ((�� `__ Roofer �tr l Other
Fiertrician_. �~ Plumber
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:._ 1n���l�t+�___ Signature _.....__ __ Date
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