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HomeMy WebLinkAbout6412 Buchanan St - Applications/Reroof - 04/24/201304/22/2013 15:46 9705322060 FLASHMASTERS PAGE 01/01 Planning, Ewvelopnxlnt & Transportation City of 281 N. College Ave P.O. Box 580 80524 Fart Cotli 1S phone Collins, CO 27,10 Pt�ne 970-416-27A10 Fac 224-6134 DVEWTHE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning L Log "+ ❑Gas ❑m Deolition (interior, non-structural) ❑ Electrical Alteration (not service change)❑Gas ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 1A Roofing ❑ Sewer Line Lighter ❑ Photo-v ltSic L09 provide make, model and ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, p manufacturer). Complete all applicable;information on the application. let a I'rcetions will not be acceated. Application For o>'� use onb lob Sibs Address (re4+a�) Property Owner Name Address r. e %id 2 Sre C Applicant Name Address Contractor Address mixsr sYxr_ , wop N - G contactor City of Ft. Collins Sales Tax* 58/es rvrnum6erls�egl�d byall mn(raclws q 9 ' lncomr3 a pP Date - tj - 2 2 -, I `5 4 Value of Construction (labor, materials, Profit) city/ate zip Phone aty/state ZJP phone City/stag Zip . Phone Are you Paying W5v s here or by report? Here ❑Report Are you Paying with your trust account? 0 Yes ❑ No Is this a residential or commercial project? 0 Residential Condo/G� rihome (single family ) ©Duplex cmmercial if residerrtlal, is it: >)d Single Family Detached Cl�� ❑MuMummify(apa p Medical office Q Office ❑ Retail If commercial, is it: ❑ Sank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Restaurant ❑ Other (expfaln) nE+ad to tnurbct Histr�iic Pn±servadon is this building 50 years of age or more? D Yes *No If yes, you may , if this is for a demolition pernft what year was the buliding construded7 If 0or to 1975, ynu W11 need an adAaMras &MmmWt k7 submit wilt this applkkadlm. Description of work *If lawn spdnld baciftm prevents', must list liwnsed plumber If first-time A (c, must list licensed electOlaan, SubcontraCIDM L& uke COrnpW.V Arne or OW of fi Coffins r ellse Other SeeV n. Plumber Med�niwl Rpofe~ 1 - 15 !� iw I hereby aciarowted9e ttrat 2 have read this apple zflon and state that d* above inforrrk'ltion is =nplete and =reCL I agree to oxnply with all requirements a MtnW herein and city ordinances and state lays regulating building I I now tF+at a permit Is not valid Until it has begirt paid and issued. Appl'UcaUrt: �S}_ �iT4Sigrrature—U6 j' Dabe�y- Z-l3 Print Name:_