HomeMy WebLinkAbout4313 Revere Ct - Applications/Reroof - 09/22/2016City f Planning, Development & Transportation
FY o281 N. College Ave P.O. Box 580
ort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 22446134
OVER-THE-COUNTER PERMITS ONLY
This application is to: be used Wapply 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 .0 Mobile Home replacement jKRoofng ❑ 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 applicationsvill not be accepted.
Application # �Il�t7�S^1 Date ZZjt?o t
For office use only
Sob. Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
N1 `,
t Vol LL
Applicant Name
Address.
City/Staten Zip
Phone
Contractor .
Address
City/State Zip
Phone
Contractor City of Ft. Collins, Sales T
#
Are you paying taxes here or by report?
❑ Here ❑ Report'
sales tax number Isrequlredbyall contractors.
Are you paying'with your trust account?
❑ Yes ❑ No
Is thi.va residential or mmercial project? Residential ❑ Commercial
If residential, is;it: 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 ❑ No If yes, you may need to contact HistoncPreserva[ron .
If this is for a demolition permit, what year was. the building constructed?
Ifpnbr to 1975, you M/l need an asbestos assessment to submit wibi this application.
Description of work 1
i
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cityof Ft Collins license #
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 ordinanc.0 and state laws regulating building construction. I know that a
permit is not valid until ithas been paid and issued.
Applicant: ,,-
Print Name: T��h� �S Signature ,c ooII m VMn:ej LA Date G LQ
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