Loading...
HomeMy WebLinkAbout5238 Fox Hills Dr - Applications/Reroof - 06/11/2013Jun 11 13 07:50p Westers Roofing 9705688448 p.1 City of I s5 S �, rt Collins Planning, Development & 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 ❑ 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 ©d manufacturer)_ Complete all applicable information on the application. Incomplete applications will not be accepted. Application # Fi�?71 J `1 Date to( I( 13 For office use only Job Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name Address City/State Zip Phone (Clio) E ck t Q A6 E I`5 5238 Gr�+-i Ds 1) . Ft . bu ks Co 28 90 plicant Name Add ress�l3S.00� %State Zip Phone �A a SLS 4776 Contractor Address City/State Zip Phone Lt Contractor City of Ft. Collins NesQ4 # Are you paying taxes here or by report? ❑ Here q Report bales tax nombersrequlred bya/l Yvdv Are you paying with your trust account? Yes ❑ No is this a residential or commercial project? X Residential ❑ Commercial If residential, is It. A. .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 SO years of age or more? ❑ Yes A"o if yes, you mayneed to contact HistoricPreservatfon If this is for a demolition permit, what year was the building constructed? If prforto 1975, you will need an asbestos assessment to submit w/ti► this appl/cation. Description of work *If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must Iist,11ol:nsed etectridan. Subcontractors: Lfst the company name or City of Ft Collins license # Becbidmi 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: r r i 2 Prim Name: Jok,WQc,40-fgSignature .2 ate J