HomeMy WebLinkAbout618 Sydney Dr - Applications/Reroof - 09/26/2011SEP/26/2011/MON 11:43 AM
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FAX No, P. 004
51229 L
Planning, Dwelopmeant & Transportation
281 M 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 far the following permit only (check all that apply). El Air Conditioning
0 Demolition (interior non-structural) C Electrical Alteration (not.service change) O Gas Ughter U Gas Log
0 Heating Unit 0 Lawn Springer 0 Mobile Home replacement 39 Roofing 0 Sewer line 0 Photo -voltaic
0 Ventilation 0 Water Heater 13 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manu%cturerj
Complete all applicable information the application. Incomplete applications will not be accepted.
o�RO
Application / 1 1
]ob;SRe Address (rwkvd)
Value of Construction (labor, materials, profit)
Property Own ame Address
City/State zip
phonecm
a
-
Applicant Name re%
CrtyjStatle zip
Phone
Contractor Address
City/State zip
Phone
SO7
Contractor City of Ft. Collins Sales Tax
Are you paying taxes here or by report? A Here
0 Report
4WMA76W;srawkedbyaawnt-ddCM
Are you paying with your trustaaoounL? 0Yes
13 No
Is this a residential or commercial project? Residential ID Cominert'al
If residential, is it: Single Family Detached Condo/townhome (single family attadied) Duplex
1Mulftffely 1313 (� ) U Garage
If commercial, is it: E3 Bank E3 Bar 13 Church .13 Hotal/Motel O Medical offl7ee Q Office 13 Retail
❑ Restaurant Q Other (explain)
Is this building 5O year s of age or- more? O Yes 13 No kye$ you May need to contact HA-M09cPlffiervabb"
If this is for a demolition permit what year was the binding constructed?
Ifp *r to 1975, yat/ kWIl creed an asbestw amwmvnwt too submit witfi bhls appl/ratAwx
of
*If lawn sj riniderlbacidiow preveMe', must list licensed plumber. If first time A/C; must list Immed electrician.
5ubcarrbacborsti W die cnmpaRy name or Cly ofR Col!ms license
Bectridan Plumber Medarucal Roofers%= _ . other .
I hereby adwowledge that I have read this appic0on and state that the above information is mmplete and corret i agree to
comply with all requiremmn.t5 wMined here and city ordinances and state laws regulating building wr ttucl on. I know that a
permit is not.valid %uM It tits been paid and issued.
applicant:
Print Name: 16- S-tr t u r-r i - Signature L.,Date