HomeMy WebLinkAbout507 Flagler Rd - Applications/Reroof - 08/19/2011Planning, Development & Transportation
,,.FCity of 281 N. College Ave P.O. Box 580
at ` Collisr� s Fort Collins, CO 80524
/ Phone 970-415-2740 Fax 2246134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply), G Air Conditioning
❑ Demolition (interior non-st: ac,ural) ❑ Elec-trical Alteration (not service chznge) G Gas Lighter C Cas Log
❑ Heating Unit ❑ Lawn Sprinkler C Mobile Home repiacenent G Roofing i7 Sewer Line ❑ Phctc-voltaic
❑ Ventilation G Water Heater ❑ Water Line ❑.Wocd/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications
will nct be accepted.
4 DGt� • ..�`
Appficatlon ,-u��{ �[ 0 i
For orice use oily
3iob, City A dddrntc �r?ry'Jlrefi� fV3:_Q or !.r`:!. � �` 3L'n (iabc;r, materials, pro*.t) .
Prope.•by Owner Name Address City/S�ata Zp Phone y/(J
r . 50-7 %r ! CO &)5 S 3 7 s�
Appliant Name 1. Ad r=_ss City/sate Zip . Fhene 9'70
gDVArlvcGZ 900�-ln9 leei►"W-$,4c{q� Ber4s 02 tndSior Co WS50 1663-0a0
Contrctcr Lc x Addr-- City/state Zip Phone
FDAaQ FQajaS 12-
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by , eper? ❑ Here G Report
Sales tax numberIsrp7Lire!�'bya17xrt2c�ors. Are you paying with your tr:s, account? I rYes ❑ No
agos�
Is this a residential or nmercal project? i Residential ❑ Commerdal
If residential; is it; Single Family pewched O Condo/townhone (single fay; ily attached) ❑ Duplex
❑ ult;`amily (aaarunent) ❑ Gar -age
If commercial, is it: ❑ Bank ❑ Ear ❑ Church 0 Notef/Motel ❑ Medical off ice ❑" CFcz ❑ Retail
❑ Restaurant ❑ O'aher (ex. -lain)
Is this building 50 years of age or mere? CI Yes O No If yes, ycu mayneed'to ccn�C±K7sionc PreservaG'on
If this is fcr a demolition permit, whet year was the building constructed?
If prlcr to 1975, you W111 ne_d an as5estes a._sessn, ent to su&mlt wt� this applicacon.
of
*if lawn spr'nider/bacelcw prevent_r, must, iist licensed plumber. If flrsi-tme A/C, rnust, list lic=_nsed e!e—_'Zican,
Subcontractors: List the car„vary ran, e Cr City ci Fc Callirs rcerse f
E!ectr;can Plurrt:er Mechanical Rcofer Lwctither
I hereby acknowledge that I hive read this application and stata that the abcva infcrrnatien is arnplete and cores. I agree to
comply with all requirements con irie: herein and ct/ ordirancss,er;d state laws regulating building construc=jor•,. I know that a
permit is not valid until it has been paid and issued.
Applicant: �]
Print Name: 1-1 11Q elCL 'Pez Signa C.
Data
IN
1/1 'dt H 01'ON 9N1300d 030NVAOd WdZC:1 HE '61'2nd