HomeMy WebLinkAbout3116 Birmingham Dr - Applications/Reroof - 12/04/2017Dec 04 17, 10:14a RMRG
9702241211 p.1
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
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
ail 6 412MiN944 $ 0� G/0D
Property Owner Name Address
City/State Zip
Phone
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Appli ant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone C-iU
Contractor City of Ft Collins Sales Tax # L4
Are you paying taxes here or by report? ❑ Here
Report
5aiestar numberisrequired byall cont.actors
Are you paying with your trust account? g Yes
❑ No
Is this a residential or commercial project? %. Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo,rtownhome (singie family attached) ❑ Duplex
LI 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 Po Ifyes, yeumayneed to contact HistoricPreservatlon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975 you w1/1 need an asbestos assessment to submit with this application.
Description of work D 0 0 f %D
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*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed ek
Subcontractors: List the company name orCityofFtCollinslicense-g ff w A 4_7- /l,ro ff,I
Electrician Plumber
Mechanical Roofer 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: ,�
Print Name: l� 1 signature Date td V— l7
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