HomeMy WebLinkAbout615 Gilgalad Way - Applications/Reroof - 09/14/2016City of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 8524
Phone 970-41616-2740 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 servepe change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ffd 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 # 516o J 3�2 Date Z`f -/i
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit).
Property Owner Name
Address
City/State Zip
Phone
Applicant Name/
Address
City/State Zip
Phone
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Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Co fins Sales Tax #
Are you paying taxes here or by'report?
ere ❑ Report
Sales tax number isrequiredbyall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or cornmercial project? IIZ< Residential ❑ Commercial
If residential, is it: USingle 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 o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was a building constructed?
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 electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer K'IS 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:
Print Name: J11 � c 11 ?,/fie ✓ Signature Date `! ' l ✓/ - l �'
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