HomeMy WebLinkAbout430 E Saturn Dr - Applications/Reroof - 10/10/2011F`;tyof ll�ns
rv�t CO �
OVER-THE-COUNTER
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 servlc change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 'Vofing ❑ 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 # /i/o U z6 Date
F office use only
Job
/ Site Address (required) Value of Construction (labor, materials, profit)
%.30 ia-tu Kn 0(- 1 $ ad
Property Owner Name Address
City/State
Zip Phone
M /l« t13 o sal
w- n Or
io_s21 x-J/a-' 9n
Applicant Name Address
City/State
Zip Phone
Contractor Lic # Address
City/State
Zip Phone
Gi)Vl'r0 Qo��ln 060A
920(, hwr
G0
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?_N�tiere ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co ercial project? b Residential ❑ Commercial
If residential, is it: 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 (ex lain
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
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 with this application.
Description of work 2 — (2 0 0 ; 4t 0 1-jr(_ f i A /e -
*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: % L►'`I_
Print Name•y asA W be +L2- Signature
Date