HomeMy WebLinkAbout1630 Tanglewood Dr - Applications/Reroof - 11/14/201311/14/2013 10:43 9704612547
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ATLAS
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Planning, Development & MransportnUon
281 N. College Ave P4, Box 580.
Fort Collins, CD 80524
Phone 970-416-274o Fax 22+6134
OVER-THE-COUIVTER PERMS ONLY
This application is to be used to apply for the following permits only (check all that apply). 13 Air Conditioning
❑ Demolition (interior non-&ucturaq ❑ Electrical Alteration (not change) ❑ Gas Lighter ❑ Gas Log
b Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacemeht�ofing ❑ Sewer tine ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑. Wood/Peilet Stove (must be EPA certified, provide make, model and
manufacturer)_.
Complete all applicable information on the application. Incomplete appucatlons will not"be accepted.
Application # /3p6$ Date
faro ilm use only
Job Sits Address (regypnd)
Value of Constmction (tabor, materials, profit)
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Property Owner Name%
Address
aty/State Zip Phone
Applicant Name
Address
City/State Zip Phone
Contractor
Address
City/State I 2'i flora4 77 �
Contractor MY of Ft Collins
Tax # q
Are you paying taxes here or by report? ❑ Here ❑ Report
SWesrarnunrderlsfeWcrredbyal/crntreerwx
Are you paying with your trust account? MBs ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
if residential, is !I--tattngle Family Detached E3 Condo/townhome (single family auadred) 0 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mot O p Medical office 0 office O Retail
❑ Restaurant ❑ Other (expla 1
Is this building 50 years of age or mere? ❑Yes . I )is, ym noynmd to contact H/stork jet t err
If this is for a dlemofloon permit, what year was the building constructed?
. fprrar to 197f, you MYnad an ads a nenttn submitWAh thisapo/lcatfon.
Desorption of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber, if i
SubconhatUrs:/.(SYQ9e[w7WaWnalmeor0tyofRCoG9rlssazasLy
9ecMdan Plumber Medonl®l
ArC, must fistfrcensed electrician.
Other
I hereby acknowledge that I have read tins application and state that the above Infomration is comptete and cone= I agree to
comply with all requirements contained herein and city ordinances and state laws regulating bullding constiruWon. 'I know that a .
permit is not valid until it has been paid and Issued.
Applicant -
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