HomeMy WebLinkAbout807 Marble Dr - Applications/Reroof - 05/03/2013City Of Planning, Development & Transportation
F6C Y 281 N. College Ave P.O. Box 580
_rt Collins 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
❑ Heating Unit ❑ 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 applicable information on the application. Incomplete applications will not be accepted.
Application # �3 / fit) c�)4 (3— Date s✓� ` I
For 67fIrLd use only d
lob Site Address (required) Value of Construction (labor, materials, profit)
-bo-4 IM0,Y612. a, $
Property Owner Name
Address
City/State
Zip
Phone
% la&A, i v`75pq
m6w ble.,
Gt. E • Cai1;+1S
5 2C.
'Iqo— (o
Applicant Name
Address
City/State
Zip
Phone
off. s6ueos 4 S4 !LxpaX,1; eve
L r.-
toS3q
q90 3q f t331
Contractor Lic #
Addre"ss
City/State
Zip
Phone
4zLk
81ud Uejamjl
6p gkosSI
170 99;-3090
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
sales tax number is required by allcontracto�s
Are you paying with your trust account? ,9 es ❑ No
Is this a residential .or commercial project? ;K Residential ❑'Commercial
If residential, is it: '"IM 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 0 No If yes, you may need to contact Historic 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 application.
Description of work f e ve. •'I••
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
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. I know that a
permit is not valid until it has been paid and issued.
Applicant: Print Name: JOL..^- `s,etireu �'S Signature Date S 3 (3