HomeMy WebLinkAbout637 Parliament Ct - Applications/Reroof - 09/12/2011Sep.12. 2011 6:03AM Bob Behrends Roofing No.3143 P. 5
City Of Planning, Development & Transportation
F' 281 N. College -Ave P.O. Box 580
®8Tt Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61M
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-strictural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Spriu ler ❑ Mobile Home replacement 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 appli ation. Incomplete applications will not be accepted.
Application #_�d1) 6�'S3 F�i7.3, Date �\
For ofce arse my
Job Site Address (required) Value of construction (labor, materials, profit)
Property Owner Name
Address
City/State
Zip
Phone
_Nv
Applicant Name
Address
City/State
Zip
Phone
Contractor Lic #
Address
City/State
Zip
Phone
Contractor City of Ft. Collins es Tax #
Are you paying taxes here or by report?-i$ Here Q Report
Safes tax num i required by aV mi&a fors.
Are you paying with your trust account
Yes ❑ No
Is this a residential or commerd tproject? Residential ❑ Commercial
If residential, is it: —b�$ingle3amily Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muffaaliy (apartment) ❑ Garage
If commercial, is it: ❑ Bank UBar 13 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurmt. ❑ Other (explain)
Is this building 50 years of agemr more? ❑ Yes-1.lo If yes, you may need to contact Historic Preservation
If this is for a demolition pemilit, what year was the building constructed?
ifpr/or to 1975, you will need amasbestos assessment to submit with this application.
Description of work
O.-U �V�S �ho�:.�:e a ova �C�\a.0 �.rec( ( \'� ��•.�g3J
*If lawn sprinkler/backflow preveder, must list licensed plumber. If first-bme A/C, must list licensed electrician
Subcontractors: List the cnmpary name or City ofR Co/llns license
Elecrrlclan Plurdet Mechanical Roofer Other
I hereby acknowledge that I haveread this application and state that the above information is complete and correct. I agree to
comply with all requirements conWhed herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has3een paid and issued.
Applicant: �C \ �� g \ pate
Print Name: �C_�-c�a_ J2 C1n � Signature 0.1�.: