HomeMy WebLinkAbout2718 Adobe Dr - Applications/Reroof - 08/12/2011ttty/ of
F6ft 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
13 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement kRocifing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must tie EPA Certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted_
Application # 'E'u�� g �' l)�� Date g� 12I t
For office use only I l7� �� I 1 449
]ob Site Address (required) n Value of onstruction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address
es�Ci State Zip Pho a 2�
&�pf_ana� So%a I l4S �. Uevr�il ✓er �(7 �Z2� '�b?i' qs f
Contractor nn n h Address ,,, City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Seiestaxnumber srequiredbyamm�tractvrs Are you paying with your trust account? Yes �(No
Is this a residential or commercial project? X.Plesidential ❑ Commercial
If residential, is it: XSingle 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 (expla" )
Is this building 50 years of age or more? CI yes
2KNo If yes, you may need to contact H/star/c Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment tc submit with this application.
Description of work QbCAyWY���c��r ✓t— ��w�
*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCRyofFtCollins license
Electrician 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.
Applicant r'
Print Nam Signature D t S� Date 010'
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