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HomeMy WebLinkAbout803 Napa Valley Dr - Applications/Reroof - 10/07/2011. Qct, 07 2011 3: 55PM HP LASERJET. FAX 1970-267-9005 p.3 Planning, Development & Transportation City of 261 N. College Ave P.O. Box 580 Fort CoWns 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 0 Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement Poofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line O Wood/Pellet Sto a (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. l� Application # i o E01-1 ►� For ofte use only Incomplete\ap Iications will not be acceW . Date \©�a`��� cJl� Sob Site Address (repulmd) Value cof ConstRuction (labor, materials, profit) Property Owner Name AdclAw city/State Zip Phone Applicant Name Address City/State Zip Phone zk Cg10 Contractor Uc # Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? _fare O Report sales{axnur IZrigq�lredbya#av&adrrs. Are you paying with your trust account? ❑ Yes 3Lao Is this a residential or commercial project? esidential ❑ Commercial If residential, Is it: ngle Family Detac ed O Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) O Garage If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hctel/Motel ❑ Medical office ❑ Office D Retail D Restaurant ❑ Other (explain) Is this !wilding So years of age or more? ❑Yes <No ff yes, you may need tO mntact Historic Preservation If this is for a demolition permit, what year was t4 building constructed? If prior to 1975, you will need an asbestos assessment to submit with thfs application. Description of work *If lawn sprinkler/backflow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician. Subcontractors: List Cre company name or Cty of Ft Collins license # � l �) 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: Date `t-- Print Name: _.� Signature lzzlk