HomeMy WebLinkAbout515 S Bryan Ave - Applications/Reroof - 11/07/2013 (2)City of Planning, Development & Transportation
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281 N. College Ave P.O. Box 580
o,} ` 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement IX Roofing ❑ 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 # ]?� I �D S S 2 Date
For ofl%e use only
Sob Site Address (requ/red)
Value of Construction (labor, materials, profit)
5(5 S- 131-a, s�
F1 6(("10 Ca. 90521
q 70 0/2!YS-oo
Property Owner Name Address
City/State Zip
Phone
Rob Ka -(r' ,S/�:.
97o21yy a�
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
/ n
m IME SYzc, s�CtN f SQ N - �aR�L6t0 1. VELgtiVO gOS3S
1
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
® Here ❑ Report
Salestax number isrequired byall mn&acbm
yS839
Are you paying with your trust account?
® Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ' ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑Church ElHotel/Motel ❑ Medical office ❑ Office ❑ Retail
El Restaurant '❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes *NO If yes, you may need to contact His#orfcPreserua##on
If this is for a demolition permit;, what year was the building constructed?
Ifpnor to 1975, you wi//need an asbestos assessment to submit with this application.
Description of work
31� SQ ua2 &
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins /ken w #
Elecbidan Plumber Mechanical Roofer 2— 151 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: R6L e-N ►J_ 76AQN Signature qJ- Date //--7-/3