HomeMy WebLinkAbout526 Peyton Dr - Applications/Reroof - 09/14/2011,J�Cityco
rt Collins
PI nnki% Development & pOr-ti10t1
281 N. College Ave P.O. Box Sao
Fort Gollins, 00 8M4
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). 0 Air Conditioning
O Demol'fion (interior non-structural) 0. Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
❑ Heating Unit. 0 Lawn Sprinkler O Mobile Home replacement Of Roofing O Sewer line 0 Photo -voltaic
O Ventilation ❑ Water Heater 0 WaterLine 13 Wood/Pellet Stove (must be EPA ce"id, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # --.B 0 01 /0V Date _ 9— _j y^ l
Foral>'f� rrse only - _
lob Site Address (regruiiad)
Vahle of Construction (tabor, materials, pnM
73Q34
Property Owner Name Address
- - City/State Zip
Phone
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A�_ -�.C,a-i►,-�f�5a5
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Applicist Name Address
city/state Zip
Phone
Contrador Address
- City/State Zip
Phone
'IPrs,ES-mc— Q�I.V,)6- (oa�p W. C-RL=ZrLO LG%LA%co 805385
_41l
Contractor Oty of Ft Collins Sales Tax #
Are you paying tam here or by report?
® Here O Report
3a/es la it nu Rs z+WH - d by j// mM
Are you paying with your trust account?
a Yes 0 No
15 839
Is this a residential
If residential, is It
If Commercial, Is It
O Restaurant - O Other (edam)
Is this building SO years of age or more? 0 Yes F# No If yw you inlay tiLW iD mnta& Hlsmne PAeMM&M
If this is for a demolMon permit, what year was the building Constructed?
lfpifor to 1975, )w WN need an astir apt m su&W widh 00s appff a► w.
E3 Duplex
or commerdal project? 8 Residential 0 Commercial
® Single Family Detached O Condo/townhome (single family aged)
0 Multifamily (apartment) d Garage
E3 Bank O Bar 13 Church O Hotel/Motel O Medical office E3 office
Description of work
0 Retail
V lawn sprinkler/back low preventer, must Fist licensed plumber.. If first-time Atq must IM licensed electrician.
subcontbaetorm Labile =Vany name or Gly of coffins /sense 0
PIWT6" Medrar1kal RWWR- 5 f b Other
I hereby adgiowWW that I have read this applkation and state that the aWve information is complete and Correct. 'I agree to
comply with all require3-1te-IM5 Contalnvi herein and dty ordinances and state laws regulating building Cansrruction. I bow that a
permit Is not valld until It has been paid and issued.
Print Name: 7,- ne.S 5"rgnature
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