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HomeMy WebLinkAbout707 Bear Creek Dr - Applications/Reroof - 12/14/2012OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). © Air Conditioning CI Demolition (interior non-structural) D Electrical alteration (not service change) ❑ Gas Lighter ❑ Gas Log * Heating Unit ❑ Lawn Sprinkler CI Mobile dome replacement 0 Roofing ❑ Sewer Line 0 Photo -voltaic ❑ Ventilation 0 Water Neater 0 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 # � I I �� ��� Date forotfxv use arty ]ob Site Address (wired) Value of Construction (labor,. materials, profit) Property Owner Name Address Zip Phone 9 ?<n VIA t ^city/state r - 3 `a Applicant Name Address city/state Zip Phone Q-7.3 / (�`� `` F Ft r�r OC.tAhiF {f 4>t7 =c t 2 l uo "�ri liiL i(o{ Co jSC7y` of a 20) C)t9c�G Contractor Address City/state Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 0 Report sages tax numtxr & rmv mo' by au axen'actom Are you paying with your trust account? 0 Yes 0 No Is this a residential or commercial project? ®Residential [3 Commercial if residential, is it: 0 Single Family Detached Q Condo/townhome (single family attached) CI Duplex ❑ Multifamily (apartment) O Garage If commercial, is it: ❑ Bank © Bar ❑ Church ❑ Hotel/Motel 0 Medical office' O Office ❑ Retail ❑ Restaurant 0 Other (explain) ---_ Is this building 50 years of age or more? Q Yes O No If yeg, jvu may need to contact Historrr. Preservation If this is for a demolition permit, what year was tree building constructed? _..................... _..__ _ Ifpror to 1975, you W11 nerd an asbestos assessment to stAwit with this application. Description of work r. e " t a—cK��-=4 x r i vL rM� 2. C..'o (7K.. t>.S' i -#i o rn ,S i }'1...41 vK'S'.. *If lawn sprinkler/backtiow preventer, must listlicensedplumber. If first-time A/C, must list licensed electrician. Subcontractors: List the cvmpanyname or OtY of R Calkins 1"n,5e A Flectndan Plamber , Mechanwat------__ 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 Name: _ i u i . a::: r :' Signature . Da 6ea7 =- — -