HomeMy WebLinkAbout4324 Mill Creek Ct - Applications/Reroof - 09/29/2011Planning, .Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phnna 97n-41 &774n FAY 77"1 u
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air ci tioning
• Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement I$ Roofing ❑ Sewer Line ❑ Photo -voltaic
• Ventilation ❑ Water Heater, 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information the application. Incomplete applications will not be accepted.
Application # `/ Cy Date i /2 9"/i )
For ofte use only
lob Site Address (mqulred) Value.of Construction (labor, materials, profit)
4324t A ( Cr,rek C�', I$ � 5-'-"-' 06
Property Owner Name Address
City/State Zip
Phone
A-w. a a . We %rc, �-1 3 Zy /1'I 11 Crr r C' F. 1~l . <d 1 i,`s r O Cy r Z6
C17e. —
2 crc
Applicant Name Address
City/State Zip
Phone
0' _�z tss;1
sic, , r �_ Ca �l ►'� r6 _ s? s-. s-r-Z
Contractor Lic # Address
City/State Zip
Phone
IiZ.-22 { ?_
7 a a -
lZk Rne "'3 lzL"t'S LL 20
"AP i./U rorvt
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? Here
❑ Report
Sales tax number cs required by all contractors:
Are you paying with your trust account? 0 Yes
0_ No
Is this a residential or commercial project? J& Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain) _
Is this building 50 yearn of age or more? E3 Yes IN 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// need an asbestos assessment to submit with this application..
Desorption of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C,. must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license
Electrician Plumber Mechanical Roofer �-Z21 2 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.
Applicant:
Print Name: �'�ci+� i �' 1� ��` ��.. Signature * Date