HomeMy WebLinkAbout1205 Midway Dr - Applications/Reroof - 03/12/2014Fort 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 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 ❑ 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 # E2� y0 «Z ` Date 3�1a�1`l
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State Zip Phone
Hark cooler
1205 Hjdl�,cY tir F160.n5 (10 8'0Sz5 a70- 310-q1) -7
Applicant Name
Address City/State Zip Phone
Vonc'4-tLc n
(91Z f2cna«gfon St FeC401("Is eo S0Sz5 303-2i0-d852
Contractor
Address City/State Zip Phone
Cooper CanSHucFoii
(8)z �L (^> �'al(�S e" .94Z5 303 4f0-6357
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report? OHere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes /XNo
Is this a residential or commercial project? 12L Residential ❑ Commercial
If residential, is it: irk Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ANo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work T e - Roo F
k 1 : re 4..-:c ris pL10 -14
own 4-0 hock.ng crr-�"k re -1-0oF
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City ofRCoimslicense#
Electrician Plumber Mechanical Roofer
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: �O/(o�t to n tau Signature `�P Date 3//Z /