HomeMy WebLinkAbout1119 Maren Cv - Applications/Reroof - 09/01/2011PortCollins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 8052.4
Phone 970-415-2740 "Fax 224-5185
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). G r Air onditi
❑ Demolition (interior non-structurai) C Ciectrical Alteraiion (not service change) G Gas Lighter ❑ Gas Los �—
❑ Heating Unit C Lawn Sprinkler a Mobile Home repiacernent 0 Roofing ❑ Sewar Line ❑ Photo-vcitaic
❑ Vertilation C Wa:er Heater C] Water Line C Wood/Pellet Stove (musi be E?A certined, provide make, mcdei and
manufacturer).
Complete all applicable information on the ap ligation. Incomplete applications will not be accepted.
Application m m &a.6 /ySag Date
For orr7ce use only
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Property Owner Name Address
City/State
Zip
Phone c?76
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Applicant Name Address
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phone R'70
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Contractor Lic # Address
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Zip
Phone
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Contractor City of Ft Collins Sales Tax
A,-= you paying ties here or by reper`? Hire u Reper`
�a/es �xnumterls,�uiredbya/I conc2ciors.
Are you paying with your
trust account?
Yes ❑ No
Is this a residential or�cc5,meTea_l project? & Resdentiai ❑ Ccmmerdal
If ressdert!af, Is it ICE Single Family Detcched ❑ Condo/townhome Csinele family aCGc`led) C Duplex
❑ Multi amily (aearwnent) ❑ GaraSe
If ccmmerdal, is it: ❑ Bank ❑ Bar ❑ Cnurth C Hotel/Motel ❑ Medici offc.0 Crlce ] RetBil
G Restaurant ❑ Other (explain)
is this building 50 years of age or mere? ❑ Yes e Ifyes, ycumaynee.'to ccntECZ H cr'c Preser✓ation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an as,5esLas assass,re,7t fe submit Prim this applicadcn.
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Li lawn sprnkie-/tac.'QyCw rrcVenter, muS list IICEnsed Plumber- If First -trine A/C, iimusl list IIca lse� eleCtr ic:2n.
Subcontractors: U� b e ccnrery ra , e or Gry of Ft Coffins license r (�
'ciecriCar• Number Me:iarical RCcfar a:..�_U,r� Other
I hereby adslowledce that I have read this zodic= on and state ii 2t ire accve infcrmat en is cgrplei2 and correc. 1 acre- to
comply with all raquif_nlentb contained herain and cit/ or6rancEs end st2te laws regulating building const,•u&lcn. I know that a
permit is not valid until it has been paid and issued.
Applicant!
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PrintName:l�iQ�CC e>?iC Signa age
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