HomeMy WebLinkAbout6813 Deerhurst Ct - Applications/Reroof - 04/29/2013Apr.29.2013 12:06 PM
PAGE. 2/
Ups
'*s
Planning, oevelopment & 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 service change) ❑ Gas Lighter ❑ Gas Log
i] Heating unit Cl Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all appliccaable information on the application.
Application #_ �/ I �V M rdq",-
Far office use only
Incomplete applications will not be accepted.
Date AaziL- Z.9,2013
Sob Site Address (rmuimd)
Value of Construction (latror, materials, proFlt)
A 3 CCiRu1P
a 00
Properly Owner Name Address
city/State Zip Phone
LAgsAiltaL Ucots &913 u>"sY
Gs •r CoW05, C0 g05Z5 6 li'-too T
Applicant Name Address
City/State Zip Phone
G2110 cwpwizrge
Contractor Address
City/State Zip Phone
2%' 0 C
-
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? l4 Here ❑ Report
sal rzrnumberlsrwolmdbyancono-aanrs.
Are you paying with your trust account? Di Yes ❑ No
N��
fV
is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: Ifs Single 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 (explain)
Is this building 50 years of age or more? ❑ Yes )al No If yes, you may need to contact HisWrlc 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 app/icabon.
Description of work ,��AF— C &� WGU(; To THE D_CCV)MG : _ WL AA 1Lfi�_S_E LT
nrt+r'V7. I'P EUGs,AnF llATE ii TiL9!M0,&(. a Q
*If lawn sprinkler/backnow preventer,. must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: LIstthe companyname orCity ofFtCollins llmnse
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. 1. know that a
permit is not valid until it has been paid and issued.
Applicant
Print Name: Signature
Date `�