HomeMy WebLinkAbout703 Dearborn St - Applications/Reroof - 09/14/2011t' "rtEolUns
Plannhlg, Devebpment a Trammor waob
281 N. College Ave P.O. Banc 580 -
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6234
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following .permits only (cheek all that appy). ❑ Alt Conditioning
O non-structural) Demolition (interior non-saural) ❑. Electrical Alteration (not service change) 0 Gas Irghter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement Of Roofing O Sewer Line p Photo -voltaic
O Ventilation ❑ Water Heater 0 Water Line O Wood/Pellet Stove (must be EPA .certiffied, provide make, model and
manufacturer).
Complete ell applicable information on the application. Incomplete applications will not be accepted.
1
Application # Date q- 11_.
Far ofte use only _
Sob Site Addres=:Wz�
Value of ConstinwHon (labor, materials, profit)
03
)a $aysg
Property Owner Name
Address City/State ZIP
Phone
703.E
fil. �o
a .!
Applicant Name
Address City/State Zip
phone
contractor
Address City/State Zip
�_ _- GaRFr>tLizi, �b 120638
Phone
' -41
Contractor City of Ft Collins Sates Tax #
Are you paying taxes here or by report?
® Here 0 Report
-We sornvftw &rmuirdbyall coro-a.cams
YSg39
Are you paying with your trust account?
® Yes ❑ No
Is this a residential or commercial project? ® Residential 0 Commercial
If residential, Is It ® Single Family Oet<rdred IZI Condo/townhome (single. family attadieQ 0 Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, Is It 0 Bank ❑ Bar 0 Church 0 Hotel/Motel CI medical office ❑ Office ❑ Retail
0 Restaurant 0 Other (explain)
Is this building 60 years of age or more? ClYes II* No JYYC*yw'maytmedfoconf&ctH!stotfcPnz&wben
If this is for a demolUlon permit, what year.was the building cones? - - -
ffpn w to 1975, you wh' need an asks assessmwi to aatzmlt w,d� chits app/icaboA
Description of work
1j
b0m sprinlder/tiaddlow preventet, must list licensed plumber.. If fast -time A/C, must list licensed electrician.
Subcontractors: List the cpmpanyname or dlcy afPt arm= rx ensu r
Eladridmn PlumberMW nkW Roofer R- IS [0 other
I hereby admowledge tint I have read this application and slate that the abbve infomNtion Is'Complebe and correct. I agree to
Comply with all requirements contained herein and city ordinances and state laws reguWng building construction. I know that a
permft is not vaUd until it has been paid and lasued.
Applicants
Print Name:R6� cPt W_ �t'SA2C Signature "w - prate