HomeMy WebLinkAbout4750 Pleasant Oak Dr - Applications/Reroof - 09/19/2012 (2)SEP/19/2012/WED 03.00 PM FAX No, P,003/007
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
iris port 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 fallowing 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 RRoofiing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). V
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Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # BrRDS(OG9 Date o-25b
For offlce use only
Job Site Address (required)
A7SU elk
6.�0_ Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip Phone
Applicant Name
Address Clty/State Zip Phone
Contractor /
Cliea A /�/o
Address �e City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report
salasnwnumber isrequlredbyall contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ® Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical ce ❑ Office ❑ Retail
❑ Restaurant ELOther(explain)A4ekznzie- ?I royr
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyas, you may need to contact Historic reservation
If this is for a demolition permit, what year was the building constructed?
if pfior to 1975, you will need an asbestos assessment to submit with W5 appl/caPion.
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins l/cense #
Electriclan 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 bullding construction. I know that a
permit is not valid until It has been paid and issued.
Applicant: �.�
Print Name: /T�' �i Signature % gate 9um