HomeMy WebLinkAbout1556 Ambrosia Ct - Applications/Reroof - 01/05/2018City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort 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 ❑ 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 i 3 5- )d
Application # &&N I. Date
For office use only
Job Site Address
Value of Construction (labor, materials, profit)
/(re-quired)
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Property Owner Name
Address City/State
Zip Phone
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Applicant Name
Address City/State
Zip Phone
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Contractor
Address City/State
Zip Phone
Contractor City of Ft. Collins les Tax # Are you paying taxes here or by report? ❑ Here pReport
Sales texnumber Isrequredbyall conbactors
Are you paying with your trust account? ❑ Yes ,ARTlo
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? EY]kesiclenbal ❑ Commercial
,�ngle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ 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 he building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
Description 9f work
*If lawn spnnkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or crty of Ft Collins license # /
Electrician Plumber Mechanical Roofer G���� 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: �y
Print Name: ./r�✓��r/� �1 Signature Date
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