HomeMy WebLinkAbout2548 Orchard Pl - Applications/Reroof - 09/18/2018Planning, Development & Transportation
City O 291 N. FFort Collins,College
CO 80524 O. Box 580 „�ort� tlms
•►` 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). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing 0 Sewer Line 0 Photo -voltaic
❑ Ventilation O Water Heater ❑ Water Une ❑ 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 # lfz / Ob 8 1 ant
For office use only
Date !2 k,ti'
Job Site Address (requ/��)
Value of Construction labor, materials, profit)
Property Owner Name Add r s
City/State Zip
(?hone _
pl[cant Name Address
City/State Zip
Phone
�6 o
1
Contractor Address
city/state Zip -
I Phone
Goptractor City of Ft. Collins Sales #
salestmrnumber isrequbedbyaUmn&vatm
Are you paying with your trust account7`o-Yes 0 No
Is this a residential or commercW project? Residential Q Commercial
If residential, is It: ❑ Single Family Detached ❑ Condo/townhome, (single family attached) ❑ Duplex
❑ Multifamily (apartment) `Garage
If commercial, is It: Cl 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 Historic Preservation
If this is for a demolitionpermit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of
*If lawn sprinkler/backRow preventer, must list licensed plumber. utf first -tole A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
L=Iecidan Plumber,
Mecranlxai P.cofar
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
oompy with all requirements contained herein and city ordina+xes and state laws reyulei g tr;llding cc. strvtilon. I know that a
permit is not valid until it has been paid and issued.
Appilcant
Print Name: i Sion Date