HomeMy WebLinkAbout407 E Saturn Dr - Applications/Reroof - 09/26/2011Planning, Developme& Transportation
FCI t�/ nt 281 N. College Ave P.O. Boot 580
ort Collins Fort Collins, Co 80524
Phone 970416-2740 Fax 224-6134
_I
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
0 Demolition (interior non-structural) 0. Electrical Alteration (not service change) Ij Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement IX Roofing p Sewer Line ❑ Photo -voltaic
p 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 # _ f3 I 18D.5
pate �" �—
FvroJirce use only
Sob Site Address (mquin d)
Value of Construction (labor, materials, profit)
00
Property Owner
Address
City/State Zip
Phone
ZNamn�(
Applicant Name
Address
qty/State Zip
Phone
Contractor
Address
City/State Zip
Phone
V\PMGs-rxc-, WOO
86S38 -
�y 11
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? ® Here
❑ Report
sales mxnumber israquuedbya#aY&acftis
Are you paying with your trust account? Ills Yes
❑ No
q5 835
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it ® Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (aparbywnt) ❑ Garage
If commercial, is it: 13 Bank 0 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 17 Older (explain)
Is this building 50 years of ? age or more. ❑Yes *No OM, you may need to wn6j:� Hisfiiic Presenebbn
If this is for a demolition permit, what year was the building constructed? —
Ifprior to 1975, you W11 need an asaeslas azesgmerrt in submit with biisaAnYMborX
Description of work KEMOvE �rgtW
*If lawn sprinkler/baddiow,pnventer, must list licensed plumber. If first-time A/C, must list licensed eectridan.
Subcontractors: List ft =piany name or City of Ft Collins lkwm a p
Electrician Plumber Medianicai _-. Roofer R- IS tl Other
I hereby adawr ledge that I have read this application and state that the abbve 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: t
Print Name: �6� C,t`+ W _ �a h2C . signaa,re ""`� — Dabs J —�L— \
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