HomeMy WebLinkAbout719 Benthaven Ct - Applications/Reroof - 05/13/2016City of Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 # 91 �d 2 J � � Date
For office use only 2l SOG
Job Site Address (required)
Value ofConstruction(I bor materials, profit)
Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
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?
❑ es No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Mu tifamily (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? ❑ Yeso If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was tfie building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
.Z 91-0
*If lawn sprinkler/backfl preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
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Subcontractors: List the. company name or City of Ft Collins license #
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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:
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Print Nae: �� Signature Date
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