HomeMy WebLinkAbout1718 Collindale Dr - Applications/Reroof - 08/23/2011EF3 tofCottins
P"MANWIftivellopmoaa-M
M it co®ege Ave ao &W 5m0
Fast COWS, Cb MM4
Phone 97"16-2740 Fax 22q-6134
PERMITS OJYLY
This aMG="= is to be used to aPPly for the �ol[oning Pwmft only (check all that apply). 0 Air Conddioning
❑ Demolition (irrterior non-sMwtural) 0 OectricatAlterat on (not mrvvice change) Ci Gas Lighter 0 Gas Log
13 Heafing Unit ❑ Lawn Sp&dder 0 Mobile Horne replacement q800finq ❑ Sewer Line ❑ Photn voltaic
❑ Ventilation O Water Heater O Wader Line O Wood/Peget S must be EPA certified, provide make, model and
manufachinrr).
Comptlete all aMrwable infomration on the won.
APPIkabon SFor office we only
kNxwrpfeW avtaftatlons will not be ac cepte&
Date 4 _-19 3 / /
S1ite Address (rerlrrnrarf)
3abnab,
Value 7io�-roateriaK,)
$pS _
Property Owner Name
i' S ("i��-',
Address City/Stake ZIP Phone .
icant Name
Address City/State zip Phone
tra tic #
Q/1� 1;W �(�
Addressr // A . City/Slade, � / zip c Phone
l'�U LiI �`�� ISp, / Jc )o�` (ij'7
Cotrbactor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? O Here CjAepwt
yes �rrewn� sfeugmadbya®aor�aciars
Are You ParOn9 with Your trust account? 01lfes 0 No
Is this a residential or qunmen- 31 project? Fennel 0 Commercial
If residential, is it: O egle Family DetachedT M� Condo/townlKn. (single family attached) ❑ pups
a O Multirdn y (apartment) 0 Carage
If eommerdal, is rr- ❑ Bank 13 Bar 0 Church lj Hoba/motel O medical ofTice ❑ Office ❑ Reta11
O Restaurant O Other (explain)
IS this building 50 years Of age or more? O Yes �Ify�s, you mayiaersd Q> mntartfftsYar�ic Fin abon
If this is far a d�if n pe�'t, v*et year was tN oonsbWmd?
JfpriPvr to 1975, yvu ev®n�eiero►an assessn�a�t� srdrrtt/t we�i Aaft0dam
Description of work *ci !/ C6 C Y-, S vf I 32:)'Sr ,
*If lawn SprkMM/b3dftw star, nrtast tist incensed phmuber. If first-time A/C; must list bowimd electrician_
Subeoatraal7ors List Me aw*mViAwm or ayofR CbMwAmruL- i
e t � otter
I he eby admowladge that I have read this apptiration ad state timt the above frftw ation Is =mpletie and correct I agree m
comply with aft rmgrm+er mft contained hereb and city ordinances and state taws regulating buitdrug construction- I Iaro w that a
pe+mit Is act valid ano it has bear paid and kmgedftPucaniz
sr pate _ q
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