HomeMy WebLinkAbout5710 Pleasant Hill Pl - Applications/Reroof - 07/19/2019Fort of
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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicabi i forr ati' theapplication
Application # �1 l I l I��L G 1
For of c se only
Incomplete applications will not be accepted.
Date
Job Site Address (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name Addre
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P�ho�nes'
A plicant Name Address City/State lip ne
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Contractor Address
City/State Zip
Phone Gi
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or cgmmercial project? IM Residential ❑ Commercial
If residential, is it: - wCj Single Family Detachdd ❑ 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
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preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # 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: %i�y /;j/ �/ J�/ I
Print Name: /!J_ (/'(/ V�(� Signature Date