HomeMy WebLinkAbout4425 Goshawk Dr - Applications/Reroof - 08/11/2014Planning, Development & Transportation
City }of I �1�1 281 N. College Ave P.O. Box 580
FOIrr` Collins 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 serve a change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet ove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
For office use only
Date
Sob S' e A dress (requ' ed)
Value of Construction (labor, materials, profit)
�) 240
Q
�
/
Prop Own Name Address
City/State Zip
Phone
li ItName Address
City/State Zip
Phone
`
Co Address
City/Stat i
Phone
Contractor City of Ft. Collins Sales Tax #
Sales lax number is required by all conbactors
Are you paying with your trust account?
❑ Yes IVNo
Is this a residential oxr-11
mercial project? ❑ Residential ❑ Commercial
If residential, is it: ngle 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?
Ifjondr to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list ligdnsed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofe( / G;�3 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) Signature
3i