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HomeMy WebLinkAbout822 Balsam Ln - Applications/Reroof - 02/25/2014Feb,25. 2014 11:17AM Bob Behrends Roofing No•7692 P. 1 }y Planning, Oeuelopment & Transportation FI �281 N. College Ave P.O. Box 580 ort Collins Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be usedito apply for the following permits only (check all that apply). ❑ Air Conditioning ❑ Demolition (interior non�trmfural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Spridder ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation O Water Heater ❑ Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable infomtation on the application. Application # C5 Z 2 BA is r "v' a For pfflte ose ma l Incomplete applications will not be accepted. Date a.��SIc�.01L1 Job Site Address (requirad) Value of Construction (labor, materials, profit) Property Owner Name Address City/State Zip Phone Applicant Name Address Zip Phone \j C�+-T.•iT. rl y\,� CCiitty`r/Sttate `D 5 \„- - W 1 1L �t �y} (0. �]U�, j 5 I J-O S' Contractor Lic # Address City/State %Zip Phone Contractor City of Ft. CollinAits Tax # Are you paying taxA here or by report?~Here ❑ Report Salestaxnurnberisrequiredbyagttm',,ants: Are you paying with your trust account?.N7Yes ❑ No Is this a residential or commerclil,project? -XResidential ❑ Commercial If residential, is it D�Single..Tamily Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Mint -family (apartment) 0 Garage If commercial, is it: © Bank Z. Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ office ❑ Retail ❑ Resiau= ❑ other (explain) Is this building 50 years ofageor more? ❑ Yes ANo If yes, you may need to contact HistorIc Preservadon •. If this is for a demolition perrdti what year was the building constructed? If pnor to 1975, you will need amasbestos assessment to submit with this application. Description of work 'T�b new *If lawn sprinkler/backftow preveaer; must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors; List the rcnpaF,I name or Gty. of Fe Collins license ,# Electrician PiLjrftr Mechanical Rnofar -c ' Other _ i hereby acknowledge that! 'nave wad this application and state that the above information is complete and correct. I agree to comply with all requirernants contaned hr_rein and city ordinances and state laws regulating building construction. I know that a permit is not valid until i-t;_1s3een paid and issued. Arolicant:\\ \,y n /y 1 '=tint rlam.e�i``C�y+lx\V __ �^ iy:i C� L fK .. ll�� _ — mate