HomeMy WebLinkAbout3207 Alumbaugh Ct - Applications/Reroof - 10/01/2012City of
�F6rt 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 servic hange) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 31,4Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable in rma 1O 1 on he application. Incomplete applications will not be accepted.
Application # p Date 1 111w2 i_02. 4 b-
For office use only
lob Site Address (required) I Value of Construction (labor, materials, profit)
$ 1UV-
Prope Owner Name Address City S ate Zip Phone
Applicant Name Address City/State Zip Phone
I.K5 S. A <,�. beAI,4f JW 80=3 .Tl;t-Z-A -t I I
Contractor Lic # Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax 4) Are you paying taxes here or by report? e ❑ RAaert
Seiestaxnumberisrequiredbvallcontractors. Are you paying with your trust account? es �'N0
Is this a residential or commercial project? IXesidential ❑ Commercial
If residential, is it: 15§1 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 (expla'
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.
Des it htion o/f' w rk vw i 3 v
*If lawn sprinkler/backflow 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 #
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: \
Print Names O&UG U"Sc - Signatw+s Date