HomeMy WebLinkAbout4312 Silverview Ct - Applications/Reroof - 08/31/2011AUG/31/2011/WED 08:50 AM
FAX No,
P. 003
31024sy
City, of 1 l $�� planning, Development &Transportation
,..} 261 N. College Ave P.O. Box 580
6 l �o��� ns 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), Cl Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement $I Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ 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_
ApplicatJon # Z' u 0(- y 3 4 b---
for office use only
Date �13\12�11
Job Site Address (required)
Value of Construction (labor, materials, profit)
S
Property Owner Name Address
City/State Zip
Phone Grc).
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
50757
Pol J mir %
7
Contractor City of Ft. Collins Sales Tax is
Are you paying taxes here or by report? X Here
❑ Report
Sa tat numDerisrequired bya//contradum
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: K 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 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact HistoricPreservalion
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit wibr bWs application.
of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& Me company name or C y of Ft Collins /keno # I '
Eleclrldan Plumber Mechankal I Roorer,� E� ,Z 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 conduction. I know that a
permit is not valid until it has been paid and Issued.
Applicant: w � � ,
Print Name: I Y f I jf_ `lTt QQ f-rU Signature Date