HomeMy WebLinkAbout5303 Cornerstone Dr - Applications/Reroof - 05/25/2016Planning, Development.&Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
LOVER -THE -COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check a8 that apply). ❑ Air Conditioning
❑ Demolition (interidr non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating, Unit ❑Dawn 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 # U 0 a-1015 Date ! a 5 d
For ofl% use only 1
Job Site Address required)
Value of Construction (labor, materials, profit)
Property.Owner Name
Address City/State Zip
Phone
30 f is
Applicant Name
Address City/State Zip
Phone
Contractor`
Address City/State Zip
Phone
0. % 1 I
" 6L/\Cf
Nomc�77-.. -
ContractorCity of Ft.Collins Tax #
Sales tax riumberis required by all contactors.
Are you paying taxes here or by report?oU ere ❑ R oi#
Are y paying with trust aaount?
your
es No
Is this a residential or
If residential, is it: <
t
If commecial, is it: I
Is this building; 50 yei
If this is fora demolil
Ifpn'or 6.1975, you m
Description of work
*If lawn sprinkler/badd
?pmerdal project? 04tesidential ❑ Commercial
.Single Family Detached ❑ Condo/townhome (single family attached) ' ❑ Duplex
Multifamily (apartment) ❑ Garage
Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Restaurant ❑ Other (explain)
s of age or more? ❑ Yes ❑ No If yes, you mayneedto contact HistorrcPreservation
in permit, what year was the building conducted?
'need an asbestos assessment to submit wdh this application.
preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby admowledge 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;
Signature
Print Name: n-N