HomeMy WebLinkAbout612 SYDNEY DR - APPLICATIONS - 4/7/201504-07-`15 11:11 FROM -Premier Roofing
FCiof
art Collins
9704848308 T-307 P0002/0003 F-603
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone,970-41.6-2740 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
C3 Demolition (interior non-structural) d Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
CI Heating Unit 0 Lawn Sprinkler El9'� Mobile Home replacement Roofing U sewer Line ❑ Photo -voltaic
❑ Ventilation O 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 # • 81 22�12. Date
For olficr use onlyly
]ob site Address (required) Value of construction (labor, m�terlals, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone"
Contractor City of Ft. Collins ales Tax # Ailn jou paying taxes here or by report? Here ❑ Report
6alastaenumber&mquiWbyall centractora: Are you paying with your trust account? ❑ Yes 0 No
Is this a residential or 9mmercial project? ';I�Resldential 0 Commercial
If residential, is it: f Single Family Detached E3 Condo/townhome (single family attached)' ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Bank ❑ ear O Church 0 Hotel/Motel 0 Medical office 13 Office ❑ Retail
17 Restaurant O Other (explain)
Is this building So years of age or more? ❑ Yes )QVo If yes, you may need in ctontactHislorfc Prpselvatlon
If this is for a demolition permit, what year was tM building constructed?
If prior to 1975, you MY need an asbastos assessment to submit with this application.
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*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or L)'ty of Ft Collins //tense p •
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: f 1Z 1-M — J5
Print Name Signature Date
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