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HomeMy WebLinkAbout2637 Dunbar Ave - Applications/Reroof - 08/23/2012Planning, Development Transportation v'�f e�Y3,4;ijj.. Ciof :,r..„,.. F6rtty, Collins281 N. college Ave P.O. Box sso CliFort 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). 0 Air Conditioning CI Demolition (interior non-stnictural) [3 Electrical Alteration (not service change) 0 Gas Lighter CI Gas Log L] Heating Unit 0 Lawn Sprinkler 0 Mobile Horne replacement M Roofing 0 Sewer Lane 0 Photo -voltaic 0 Ventilation 0 Water Heater Ei Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete cation will not be accepted. 107 Application #_ g Iz'5< I D Date For office use Only Sob Site Addres (regal value of Construction (labor, materials, profit) Property Owner Name Address CS /State Zip hone AAA Lei I r L' X. 216� 1AArl ON k nc I Applicant Name Address City/State Zip Phone -}" Contractor Lic # Address 9-me city/State Zip Phone :W.41CD w2u lwac&q Contractor City of Ft. GAIns Sales Tax # Are you paying taxes here or by rei'port7}iere Report sales tax number is wulred by al1 contractors Are you paying with your trust account? Yes No Ts this a residential or mercial project? Residentlat i3 Commercial If residential, IS It: Ingle Family Deta ed 0 condo/townhome (single family attached) Duplex Multifamily (apartment) (3 Garage If commercial, is it: E7 Oank E] Bar 0 Church 0 Hotel/Motel 0 Medical orrice l] Office 0 Retail 0 Restaurant Cl Gather (explain) Is this building SO years of age or more? M Yes ©No if yes, you may need to contact Mistodc Preservatlon if this is for a demolition permit, what year was the building constructed? tf prlor to 1975, you will named an asbestos assessment to submit with this applicatlon. n of work *If lawn sprinkler/backfiow 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 r Other I hereby acknowledge that I have read this application and state that the above Information is comply with all requirements contained herein and city ordinances and state laws regulating bi permit is not valid until it has been paid and issued. Ap plicant: `1 Print Name; Signature and correct. I agree to structlon. I know that a W6—. '025 ,I O T-d 9006L920L6 0WI 9WId008 S00I1 Wd6T=S 0102 62 2nd