HomeMy WebLinkAbout1707 Dora St - Applications/Reroof - 09/28/2011 (2)09/28/2011 10:21 9702669123 DRENNEN CUSTOM CONT PAGE 01/01
For t Collins
planning, De OlOpment &TrerspOrlat10n
281 N. College Ave P.O. Box SW
Fort collins, CO eos24
Phone 470.416-2740 fax 22"134
OVER-THE-COUNTER PERMITS ONLY
I for the folbwimg permits only (check all that apply). ❑Air Conditioning
This application is to be used to apply ❑ Gab Lighter ❑Gas Log
O Demordion (interior non-structural) O Electrical Alteration (not sen�lce change)
Heating Unit 0 Lawn Sprinkler. 0 Mobile Home replacement ,Roofing 0 Sewer Una ❑ Photo -voltaic
❑ Ventilation .C1 Water Heater Q Water Una 0 Wood/Pellet stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable ir1fornwttiOnn On the application. incoimplete aPPlications will not be accepted.
Application #_ I� k )1 `� Date-
F& ofoe use only
30b Site Addrew (n w4 Value of Construction (labor, n>ateials, profit)
/%W- o D
Property owner Name Address City/State Zip Phone
O
CA A05a1,e OU-0 -1
Address City/SCaC® ZIP Phone
pppllrantName T//t%6 _ S
v �1e •u Phone
Contractor Address oty/State ZIP
60Aa5a7 970
contractor city of FL Collins Sales Tax Are you paying taxes here or by report? Here 0 Report
raxrrtor�lrrisre byaumrrtrecmrs Are you paying with your Ma aoeouflt? Ales 13 No
is this a re *ienU or commetrlal project? '%esdentlal O Commerdal
If residential, is It y,d�.�s.ingle Famity Detached O Co /b;wnhome (single famdv attached) ❑ Duplex
�ltfa 43 Mtmly (aparbnent)Garage
if commercial, Is Ft0 Bank O ear D Church ❑ Howl/Motel 0 Medical office Cl Office ❑ Retall
11 Restaurant O Other (explain)
Is this building BO years or age or more? ❑ Yes a No if yes. you inlay nnsd m owrbct HAM?r c Prc5urraSon
If this is for a demolition permit, what year was the building constructed?
lfpnor to 1975, YvV w1l need an asbestos asses wwt 0 submit with this 80k9bion.
Description of work
xrf lawn spr1nider/b3ckflow preventer, must list licensed plumber. if first-dme A/C, must Ilk licensed elactidan.
Subcontractors; USt bV axnpW name or sly of M aAhS irrerue #
9ectridar` pp,mber Mechanical Roofer Outer
1 hereby adawwledge that i have read this application and Bata that the above W mtatim Is complete and correct. I agree to
comply with all requirements contained herein and city ord cones and sWteiaws reguisting hAdlog construction. I know that a
permit is mot valid until it I>emt been paid and issued.
nppllcanCDate
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