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HomeMy WebLinkAbout413 Saturn Dr - Applications/Reroof - 09/20/2011Planning, t evelopta1F�nt SL Transp,Ju"tatioil „ i'L'� c �,; ,, „ 281 N. College Ave P.O. Box 580 w ., Fort Collins, CO 80521 .', � Ins Phone 970-416-2740 Fax 221-61:34 AVER- AM UN` ER R �.A O `l,his appiir,,atior s is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement KRoofing ❑ Sewer Line ❑ Photo -voltaic 0 Ventilation ❑ Water Heater ElWater Line 0 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 # Q Bate —_._6For office use only Job Site Address (required) Value of Construction (labor, materials, profit) Property Owner Name Address ' City/State Zip Phone T &ro ld_ 0 /3 5a/V/'ri g /i�" r Applicant Name Address City/State Zip Phone oso -� y� AV e- r � �10._3a,2ri 7o7-76?- Contractor Lic # Q 1? / Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? fflKhere ❑ Report sales tax number tsrequired byall contractors Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project?. 16 Residential ❑ Commercial l� If residential, Is it: Single Family Detached © Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) � `❑ Garage"' If commercial, is it: ❑ Bank ❑ Bar .11 Church. ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license# Electrician 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'.�� "�