HomeMy WebLinkAbout720 Glenloch Dr - Applications/Reroof - 07/12/2013Fort Collins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134Jr
,J
OVER-THE-COUNTER PERMITS ONLY � �l
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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement KRoofing ❑ 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 application. Incomplete applications will not be accepted.
Application #B 1 W 3 -A�
For oA%e use only
Date 16113
Job Site Address (required)
O Glan l I
Value of Construction (labor, materials, profit)
f 2 2 GO
Property Owner Name Address
City/State Zip Phone
Vim fiex 1,76 AlenixViDri
ve + Milts CO S - 1-Gs8
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
e 6Fi . CL cut II C7 fcSfv
rt �l�Cblllns 8D52S °I t0-�°(-I--Z5 -2
t: Collins es Tax #
Contractor City of Ft-.'Collins'
sales tax number is required by all contractors.
Sh�30
Are you paying taxes here or by report? X Here ❑port
Are you paying with your trust account? No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: $21 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes n 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.
ption of work
(A
Trojig"t-11W am, \1P.Okkin1tvil- lrxD 1��11 Y\t -•lam
*If lawn sprinkler/backflow preventer, must list licensed p umber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electridan 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 la s regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: _YteV2 �f2�dS /
Print Name: UJ Signature Date