HomeMy WebLinkAbout2830 Bluegrass Dr - Applications/Reroof - 09/05/2017y2$-2JD
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134 LCJtoyy
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OVER-THE-COUNTER PERMITS ONLY V ( e
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Cond
❑ 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
.rant darrnrarl
Complete all applicable informa�tl jon on the application.
�Application # ) 6 U" )
For nflire use on1v
incomplete applications will not be accepted.
9— 5 -
Date I
39b Site Add (required)
Value of Construction labor, materials, profit)
Property Owner Name
Address .
City/State
Phone 70
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Applicant Name
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Address U
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City/State Zip
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Phone q70
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Contractor
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Address
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City/State Zip
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Phone
9lo-aa3-d1.13
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report? Mere ❑Report
Are you paying with your trust account? ❑ Yes )XNo
Safes tax number esrequired byall contractors
Is this a residential or commercial 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 (exNla'n)
Is this building So years of age or more? ❑ Yes No If yes, you mayneed to contact Historic Fireservat/on
If this is for a demolition permit; what year was the building constructed?
if prior to 1975, you wi// need an asbestos assessment to submit Wffi this application.
*If lawn sprinider/bade low preventer, must list Iicen plumber. If first-time A/C, must list licensed electridan.
Subcontractors: List the company name or C.riy of At co/l/ns l/amse # g " Rq43 p
ElectMclan Plumber Mechanical Roofer /2^� 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:
Print Name: , `� ✓� Yr Signature Date
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