HomeMy WebLinkAbout440 Circle Dr - Applications/Reroof - 10/03/2011Fort Collins
Planning, Development & Transportation
281 N, 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 for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
D Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ® Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ 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 #.
For office use only
Date ) 0-2 -ao I
Job Site Address (required)
Value of Construction (labor, materials, profit)
tiG
o 11. 9
Property Owner Name
Address City/State Zip
Phone
4 40
Applicant Name
Address City/State Zip
Phone
Contractor
Address City/state Zip
Phone
Vf [AT6S-rtc
W- CrwozeLo \-0\)6L0'No 8Q53s
9-�► 11
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
N Here ❑ Report
sa/esraxnumberifsrequlredbyaaconbadors
Are you paying with your trust account?
® Yes ❑ No
9'S �39
Is this a residential or Commercial project? ® Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 60 years of age or more? ❑ Yes I* No If yes, you may need to contact NistnricPnservafion
If this Is for a demolition permit, what year was the building Constructed?
If prior to 1975, you wi/1 need an asbestos assessment to submit with this application.
Description of work REMOVE -ro Duct, Neig NRLL ?m Sirlivtj)_E
*If lawn sprinkler/baddlow preventer, must M licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or Gty of Ft Collins license 0
Electrician Plumber Mechanical Roofer 15 / 0 Other
I hereby acknowledge that I have read this application and state that the abtyve Information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state taws regulating building construction. I know that a
permit Is not valid until it has been paid and issued.
Applicant: R6� CSt LL �1ane, , Signature � � Date l o -3 -
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