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HomeMy WebLinkAbout416 Clover Ln - Applications/Reroof - 07/01/2013Jul. 3. 2013 5:014 ADVANCED ROOFING No•6392 P. 1 Fort Collins 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 pennits only (check all that apply). ❑ Air Conditioning ❑ Defnoliti6h (ifiterief 116ft-Stru tiiell) ❑ Eleetrieal Alteration (lint seiiiiee change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater O 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 # fit �Q n7 For ofte use only Date Sob Site Address (required) value of Construction (labor, materials, profit) Property Owner Name Address Gty/State Zip Phone Applicant Name Address City/Statee Zip Phone l Atbv-auod f - I ,° Lt(j4(c c' ' �. ' L,t.�,�A-s'1 —9C)o Contractor V J Address City/State Zip Phone LL Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sa/esbznumber krepuiroWedp all contraaom Are you paying wits, your trust account?$Yes to , Is this a residential or commercial project? C144sidential ❑ Commercial If residential, is it: L545 ftle Family Detached ❑ Condo/bowntwme (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church © Hotel/Motel O Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (expl in) Is this building SO years of age or more? ❑ Yes hNe If yes, you may need to contact Hi-q�oric Preselvabbn 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 with this appl ration. Description of worN *If lawn sprinkler ddiow preventer, must list li sed plumber. If first-time A/C, must list licensed electrician. Subcontractors. List the company ncamE or Gty of Ft Collins / enX 2 # Electrician Plumber Mechanical Roofer Other I hereby adttl0wled0e that I have geed th1S application and State that the above information is Complete and correct. I agree to conply with ail 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: ((��� If�� (� ` ' , ' ' 1 Print Name:_ITiY� 1 � A -\k% VU Signature - Ly In U t�Il Ae1 Date � �