HomeMy WebLinkAbout1551 Corydalis Ct - Applications/Reroof - 11/28/2018Ciof
Fort 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn.Sprinkler ❑ Mobile Home replacement Aoofing ❑ 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.
Application #� �`� Date It IQ911b
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
155 N 0OU14 �1
Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Lic # 1-133 Address
City/State Zip
Phone C"l- 0
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Contractor City of Ft. Collins Sales Tax # L41 ?j-1Lp
Are you paying taxes here or by report? ❑. Here
)!Q Report
Sales tax number isrequiredbyall contractors.
Are you paying with your trust account? X Yes
❑ No
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 (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 demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer; must list licensed plumber. If first-time A/C, must list licensed
Subcontractors: List the company name or City of Ft Collins license
Electrician Plumber Mechanical Roofer () W ClY P ;Z 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: 1
Print Name: y��� ` signature - vDate
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