HomeMy WebLinkAbout7127 Egyptian Dr - Applications/Reroof - 08/25/2011rites "F
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Planning, Develemnent & Tm.m..:rm::....
..`} 281 N. College Ave P.O. Box 580
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Fort Collins, CO 80524
Phone 97"16.2740 Fax 2246}34
OVER-THE-COUNTER PERMITS ONLY
This applicatlon to to be used to apply tor, the following PermRs only (check all that apply), Q Air
ondMoning
❑ Demolition (Interior non-structural) D Meetrkcal Alteration (not serv�l change) 0 Gas Lighter 113 Gas
❑ Heating Unit 0 Lawn Sprinkler
Log
0 Mobile Home replacement LolRoofIng 0 Sewer Line ❑ Pjr
ltalc
Cl Ventilation 0 Water Heater ❑ Water Line ❑ WoodlPellet Stovo(must be EPA certified, provide me
e, model and
manufacturer).
Complete all applicable indormadon[o�n the application. Incomplete applications will not be Accepted.
Application # ��J� Cj Date
roraNketoally
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Job Site Address ( Value Tnsbuctlon 0 , m'a
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, profit))
Qtit (DO o
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Property Owner m % Address City/State2"ip
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Phone O
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Applicant Nai6e Address City/State Zip
Phone
Contractor Address City/State Zip
I Phone 3JO3
1- err ` ,
`L114--u 3
Contractor City of R, Collins Tax # Are you paying taxes here or by report? E'KH
Saks bye# avommm Are
0 Rgport
you paying with your trust account? 0 Yes
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Is this a residential or commercial proje d? eilesidential ❑ Commercial
If residential, is it: 0 Single Family Detached 0 Condo/townhome (single famlly attached) O C upleil
0 Multifamily (apartment) ❑ Garage
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If commercial, is it: Cl Bank ❑ Bar 0 Church O Hotd/Motel 0 Medical office ❑ ORlce 0 Retail
0 Restaurant 0 Other (exp!au)
Is this building 50 years of age or more? 0 Yes VNo 1'fkw. you mayneeeif m ronlactHLobrlc
V this is for a demolltlon
on
permlt, what year was the building constructed?
I
Yprfor to 1975, yak/ *0/ne+ed an asbaft s a.smwwtto sr&rn/tWM &N app/kadcn.
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r
ption of work
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*If lawn spdrilder/baddlow preventer, must list ilcensed plum . If first-time A/C, must list licensed electxioa in.
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Subeontractore: L& me maWW nmw or Gty ofRCo&);$ 4twN 0
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Elemdar�Plutntxr Medunicid. aRoofer-R-ae� � i othei.
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I hereby acknowledge that I have read this application and slate that the above Information is complete and ccqq!nect.
comply with aft requirements herein
I agree to
contained andcty ordinances and state laws regulating building condsuctJbn. I
know that a
permit Is not valid uWA it has been paid and Issued. I
Applicant:
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Print name•_ aoslig E ►Tf'PifP.r/
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