HomeMy WebLinkAbout2831 Trenton Way - Applications/Reroof - 08/22/2013City 0f Planning, Development & Transportation
(! , 281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
~_ Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
0 Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement XRoofing 0 Sewer Line 0 Photo -voltaic
0 Ventilation 0 Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information Ionth�etapplication. Incomplete applications will not be accepted.
Application # rJ y y (P`'[` Date _ e- as
ror ofike use only / e� �F� � —
Job Site Address (required)
Value of Construction (labor, materials, profit) oZ�
283 1"rcvt�w,cai
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000..-5�.-
Property Owner Name
; Address
City/State Zip
Phone
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Appy'cant Name,
Address
City/State Zip
Phone
Ka c +
4900 13
Vitt") DK Tf, ih Cv- 9054
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Contractor
AddressJ
City/State Zip
Phone.
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LHoo JbLo4 View Dy' gosz
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
ere ❑ Report
,rPsmxnumber.sregvimdbyaucorruarnws.
Are you paying with your trust account? ❑ Yes "o
Is this a residential or co mercial project? Residential E3 Commercial
If residential, is it: Single Family Detadfed ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: 13 Bank O Bar 0 Church 0 Hotel/Motel 0 Medical office 0 Office 0 Retail
❑ Restaurant 0 Other (explain)
Is this building 50 yearsof age or more? O Yes XNo If yes, you may need to contactHestoric 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 widr tlrrs applicabon.
{{ Description of work _- 'CL - '(04 f'cMOVe." ccvlot IrSP14C. ('Oaf. JLi
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If lawn sprinkler/badtflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the aornaany name cr Gty of CollmN lxenae # paC 3, LiG.
Degrieian s, Plumber Mechanical_- ... _ _ _ Roofer ,l\-_Z 3kL ._ Other
I hereby admowledge that I have read this appliwtion and state that the above Information Is complete and cones. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building constriction. I know that a
Permit is not valid until it has been paid and issued. .
Applicant: /
Print Name:, �'�*� { tl,{� sigrwture ,t - 10fn Data