HomeMy WebLinkAbout5205 Mail Creek Ln - Applications/Reroof - 08/24/2011 (2)Aug 24 11 10:16a Atlas Roofing 9702661821 p.1
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6rt 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 replacement41'ftoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line O 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 # j�'-l1()511/ '$ M:7-0 Date
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Address City/State Zip Phone 11-3
Applicant Name
Address
City/State Zip Phone
ontractor
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City/State �C�� �^ o e 7�%
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Contractor City of Ft. Collins gAs
Tax #41 U 3$
Are you paying taxes here or by report?A-here ❑ Report
saxes raxnumberitreyurredbyaucontactors.
Are you paying with your trust account%=A-Yes ❑ No
Is this a residential or co��'ieal project? ,0'ftesidential ❑Commercial
If residential, is it: ZI 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 . o Ifyes, you may need to CorrlactHistonciRresemation
If this is for a demolition permit, what year was the building constructed?
!f pnor to 1975, you will need an asbestos assessment to submit with this application.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontracbors: List the company name or City of Ft Collins license 9
Electridan Plumber Mechanical Roofer
Other
A
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. Z4 i
Print Name: ��� �� l it Signature Date I