HomeMy WebLinkAbout743 Marigold Ln - Applications/Reroof - 09/28/2018Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appli/ca le inform do onnt�thle application. Incomplete applications will not
be accepted.
Application # -G-- Date`s
For offIre use only
Job Site Address (required) (—e? ADS (o Value of Construction (labor, materials, profit)
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Property Owner Name Address -6ve� Gty/State c Zip $Us a (o
Phone / 70
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Applicant Name , d Ua h f-e d Address b-) i S 0 r City/State CO I ca Z1p f:2 S1 J
Phone
D T2 S —
Contractor Address /State Zip
Phone
L7v 2S -
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here- ❑ Report
Saks tax number is required byall rontractas Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? •IP-Residential O Commercial
If residential, is it: �'Sngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex /
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail T
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes -A No If yes, you may need to contact HLstonc Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/back law preventer, must list licensed plumber. If first-time A/C, must list licensed elecbrician.
Subcontractors: List the company name or City of R Collins license #
Electrician Plumber Mechanical Roofer r�
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. l�
Applicant:
Print Name: n_ CSignature. Date / d"