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HomeMy WebLinkAbout719 S Lemay Ave - Applications/Reroof - 09/04/2012V.N-09-04-12;13:04 ;From:rtn roofing To:2246134 ;9705931119 # 1/ 2 of Flirt 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 D Heating Unit ❑ Lawn Sprinkler 13 Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo -voltaic • Ventilation 0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information onthe tb he application. Incomplete applications will notbeaccepted. Application #. l c�4 1 J Date — l 1-73.53 For olrice use only Sob Site Address (required) Value of Construction (labor, materials, profit) lq S. I KA Av-e . 622, /i . oo Property Owner Name I Address City/State Zip Phone O!z /5e54A, A -1 ^-1 C. 102 Corvnvd evCt 1, 5jt _ E-7"C BD.S"252 q7O Applicant Name Address city/state Zip Phone :TeFf- LLozOyi �'3��' t.oc fee fives Lave_�L" Co $D533 0-5`13-1 00 contractor Address City/State Zip Phone I�L.7of- (T �c: Al -h'[nlC� it 11 �t A Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? {Here D Report Sales tax number Isrequlmdbyall contrvctors Are you paying with your trust account? C7 Yes g No Is this a residential or Commercial protect? ❑ Residential IQ Commercial ❑ If residential, is it: Single Family Detached ❑ Condo townhome (single family attached) • ❑ Duplex ❑ Multifamily (apartment) E3 Garage If commercial, is it: ❑ hank ❑ Bar 13 Church ❑ Hotel/Motel ❑ Medical office © office ❑ Retail J& Restaurant . ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes O No If yes, you may need to contact Historic Preservation If this Is for a demolition permit, what year was the building constructed? if prlor to 1975, you will need an asbestos assessment to submit with this application. of work *If IaM sprinkler/backflow preventer, must list licensed .. If first-time A/C, must list licensed electrician. Subcontractors: List the comoM name or Gty of R COMM license 0 ' 7 E mbidan Plumber Medwnical Roofer ''� 5 / Other 71: 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. PrName: nplicant: S71r� /� /, (ri�M � Ci�Gtli Signature Date / �q//-2 Print