HomeMy WebLinkAbout300 Mae St - Applications/Reroof - 09/19/2011.Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
ort Collins Fort Collins, CO 80524
% Phone 970-416-2740 Fax 224-61M
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) 0 Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
• Heating Unit. ❑ Lawn Sprinkler ❑ Mobile Home replacement JS Roofing 0 Sewer Line ❑ Photo -voltaic
❑ Venfilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be.EPA certified, provide make, model and
manufacturer).
Complete all app�Td_o
'le information on th pplication. Incomplete applications will not be accepted.
Application # __ _ Date l�
For off% use. only
.lob Site Address (repulred) Value of Construction (labor, materials, profit)
3 00 MCI e. $ � o v'
40
Property Owner Name
Address
City/State
zip
Phone
Ste-tI a SP%
err 00 Ola
Feet- Co 10t*x sko
COSZ% C-i�2-11
Applicant Name
Address
City/State
Zip
Phone
Sfe I of
dam_ 3190 Wf-
411r0 Go _
_ rd oS26.
�7D)2Z7-7/fJ
Contractor
Lic # Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Saks tax number,& required by all cnntractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: CH Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
13 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 ®No If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you wi// Reed an asbestos assessment to submit with this application.
besaiption of -work ],=
*If lawn sprinkler/baddiow prter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the comp&W name orOty offt CoYIns rcense #
decbidan 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.
Print Name: 57heef tat 54%f-der- Signature ��� Date 12