HomeMy WebLinkAbout903 Glenwall Dr - Applications/Reroof - 08/17/2013Ginty. of 1 Q
oft, Cottins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not serv�! a change) ❑ Gas Lighter ❑ Gas Lag
0Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Loofing ❑ Sewer Line CI Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Cl 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 #_ 3ti Lt3-1p,. Date 1-1 A%J 2.oM
For office use only . .
Job Site Address (requlred) Value of Construction (labor, materials, profit)
1I03 ( LgLz_ Vq4- 5- .8d . $ 6
Property Owner Name Address City/state Zip Phone
15,A)KE-4 i silts °O-$ QA WW" DR Wr QLU IJ 00524 Q70 all 9,a'l
Applicant Name Address City/state Zip Phone
Contractor CK[-tt vv n[ Address City/State Zip Phone
ST goolpiq S BIKH Cr bmt&R LO w2lz2 ZGE3 1304 �30
Contractor City of Ft, Collins Sales Tax ## Are you paying taxes here or by report? M�`iere ❑ Report
Sales tax num r is Ae by all contractors Are you paying with your trust account? O Yes ®'No
Is this a residential or commercial project? iiResidential ❑ Commercial
If residential, is it: W Single Family Detached ❑ Condo/townhome (single family attached) Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: CI Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 13 Other (explain
Is this building 50 years of age or more? ❑ Yes . o If yes, you may need �o caantactHistoric Preservation
If this is for a demolition permit, what year was the building constructed? � P.
Ifpriar to 197!, you will need an asbestos assessment to submit with this applIcatlon.
of work
E W i"
Ji A4L.L i3C (5 t1Nl (Q LAYI-"Zt
*If lawn sprinkler/backFiow preventer, must list licensed plumber. If first-time A/C, must list Ilcensed electrician.
Subcontractors: List the company name or City cf Ft Collins license #
Electrician Plumber,
Mechanical Roofer 3166-f, 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;
Print Name: B1l4L _ UN2.W Si9 Hato
Date 1'7Im