HomeMy WebLinkAbout2301 Berkshire Dr - Applications/Reroof - 08/08/201108/07/2011 14:33 970-669-3231 FEDEX OFFICE 0486 PAGE 02
cCit OF Planning, Development & Transportation
,FortCollins For N. College Ave P.O. Box 580
o Fort Collins, CO80524
Phone 970-416-27402740 Fax 2-24-6134
OVEWTHE-COUNTER PERMITS ONLY
Thia. 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 01 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 # 13 110 q�162 Date
Far offce use onlit
3ob Site Address (mgifred) Value of Construction (labor, materials, profit)
a?3ol t36Rk4s 6 DQ Fc SOS $2-733,010
Property Owner Name Address
city/State Zip
Phone
.BEiH /,-0 a),30 6 ,tR6
04 Fr -Ace 4065za
C.7a1-3QVS
Applicant Name Address
city/State Zip
Phone
AAuip 6. P A^ g 7.3,9 --5Nt:A"0AfJ 40� cc -a CL57
L6 ' �3
Contractor Lic # Address
C
city/Stage Zip
Phone
Contractor City of FL Collins Sales Tax #
safes taxnumb�r ar gmwbya#cvnaacmix
3 0/
Are you paying taxes here or by report?
Are you paying with your trust account?
® Here ❑ Report
® Yes No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, Is It: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retaii
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? .13Yes ®No . If yes, you may need to wntact NisYoortc Prese vadon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbesivs assessment to submt with this applirabon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-Ume A/C, must list licensed electrician.
Subcontractors: List the company name or Ctyof R Collins rxense #
ER/lsif0
Electridan Plumber Mechanical Roofer0,442Z,4 - - Other
1 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: Qa d, a t P8A -a •,"__09 ' nature 0�_ � �_ Date S 7 /f j