HomeMy WebLinkAbout1968 Massachusetts St - Applications/Reroof - 09/14/2011®i t Collins
City af
Planning, Development & Transportation
281 N. College Ave P.O, Box 560
Fort Collins, CD 80524
Phone 970-416-2740 Fax 224-6134
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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
❑ Heeling Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water line Cl Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information onntthe application. Incomplete applications will not be accepted.
Application #_ Fpl I��('�noO �'1
For offce V.5e only
Job Site Address (required,' Value Of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone (01176
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Applicant Name Address C Sta Zip Phone
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Contractor Address city/State Zlp Phone
a)L~kbF (fir i•,a�` ya �o i55 �. Sewe.�l Atvc,St'e ►tcc�
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Contractor City of Ft Collins Sale�"ax # Are you paying taxes here or by report? JS Here ❑ Report
saestarnume}v^t�(�u;�dpyaamnaacm+s Are you paying with your trust account? ❑ Yes Iq No
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Is this a residential or commercial project? Residential O Commerdal
If residential, is it: A Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
O Multiramlly (apartment) ❑ Garage
If commercial, is it: O Bank ❑ Bar ❑ Church C3 Hotel/Motel ❑ Medical office ❑ Office ❑ Retell
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes A No If yes, you maynee'd to cYvttact Historic Ptldservadon
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975,, you will need an asbestos assessment to subm/tW0 thIS apofrcation.
Description of work —% ' Y h+C11�1_
J 'ol�Z mq� i Q ✓ E,s _
*If lawn sprinkler/bacidiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcon bra ctors: List the mmpany name or City of Ft Collins A>° m #
Oecoiclan _ Plumber Mechanical Other
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I hereby acknowledge that I have read this application and state that the above Information is complete and correct. I agree to
comply with alf 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; tZ.n Signature ' h Data