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HomeMy WebLinkAbout3708 Elgin Pl - Applications/Reroof - 07/13/2013t 107-3z 8Cfty of Planning, Development & Transportation O` }} �^+ 281 N. College Ave P.O. Box 580 ' yt ,7oLlins Fort Collins, CO 60524 /\ Phone 970-416-2740 Fax 224-6134 I�V� OVER-THE-COUNTER ■ ERf ITS ONLY �?`r This 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 servpoIo change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O'Roofing CJ Sewer Line . ❑ Photovoltaic Q Ventilation ❑.Water Heater 0 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 # J � Date G, SUlaf 2013 For office use only _ Job Site Address (required) Value of construction (labor, materials, profit) Property Owner Name Address City/State Zip Phone LF�11 1� �pi's= 3"Zc (t3 91L. FoQr CowNS (0 8oi5M.A 9-Lo 420 Mqj Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone NOM-0 WRET OtFWL 7120 5-KIRC.H sT DIE44 z Co 4�sZ_ Z 363 am 0303 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 19'fiere ❑ Report Salastax number��^qu �llby all Are you paying with your trust account? ❑ Yes srfio Is this a residential or commercial project? Residential [J Commercial If residential, is it: 61ISingle Family Detached ❑ Condo/townhome (single family attached) 0 Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: 0 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office © Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes WNo If yes, you may need o contact HlstolicPreservation If this is for a demolition permit, what year was the building constructed? ��� If prior to 197S, you will need an asbestos assessment to submit with Mis application. Description of work IMM hU. =KLS of CC XMP14Rur a 'L W M L vQI Z rr1D - 7-&6qL *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 llcenSe # Electrician Plumber Mechanical Roofer 7. tl 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: Blta. t�.1= Print Name:—��,,,,,, Signatural__� Date