HomeMy WebLinkAbout3731 Carrington Rd - Applications/Reroof - 05/23/2016of �L� Planning, Development & Transportation
FCity, f . � 281 N. College Ave P.O. Box 580
6 1. Collins 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 XRoofing ❑ 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 #-2 I () Date _QUl !�
For office use onty
Job Site Address (required)
Value of Construction. (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone c7W
F5or�` l
Applicant Name
Address
City/State Zip
Phone
Contractor # —l�`3 3
Address
City/State Zip
Phone4�
p el"A %NL O. Jam+ *er L J
Contractor City of Ft. Collins Sales Tax # Ll 13 (o
Are you paying taxes here or by report?
❑ Here 19 Report
sales tax number isiequiredbyall contractors,
Are you paying with your trust account? 91 Yes ❑ No
Is this a residential or commercial project? 411esidential ❑ Commercial
If residential, is it: {L 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 lir-No If yes, you may need to contact Historic Preservation
If this is for a demolildon permit, what year was the building constructed? "D
If prior to 1975, you will need an asbestos anent to submit with this application.
Description of work
*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-tirde A/C, must list licensed electrician.
Subcontractors: List the company name or Crfy of Ft Collins license # 14.k1&,rcp-.-? wr( UAL -
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. •- .t
Applicant: 1
Print Name: 0 /� Signature
Date
I r wD;�- V4C c_L-_%_),rJ t-