HomeMy WebLinkAbout833 Napa Valley Dr - Applications/Reroof - 09/06/2011Cit of Planning, Development & Transportation
®�l �o����S S bs� 281 N. College Ave P.O. Box 580
Fort Collins, CO 854
Phone 970-41616-2740Fax 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
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O 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.
Application #
For office use only
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
S33 NOWA VALLZI 02 F—c-c,) $ /9762,00
Property Owner Name
Address
City/State Zip
Phone
0<"r'S (uc.ka
33 NnP�v�u�
oK FC Co R0525
970 Y'V 6-73i
Applicant Name
Address
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
StaULIaN Roo4
5104 t✓, Ca_-
� (_0
70 541 766
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here t&Report
Sales tax number is required by ai/Contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ld Residential ❑ Commercial
If residential, is it: SW 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 SO years of age or more? ❑ Yes 19 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if,orior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Q.., « to «�<. �� t. L� CAg6zLIC „m(3�. Lt�� 14tp
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins 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: �_ M
Print Name: Signature Date