HomeMy WebLinkAbout523 Peterson St - Applications/Reroof - 10/20/2011Oct 20 2011 8:53AM HP LRSERJET FAX P.1
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11 Uti '�12i�s e�6
tlanning, Development 0 Transportation
Cot8Nottins Fort 281 N. College
Ave
P.O. Box 500 Ij
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This applieatlan is to be used to apply for the following permhe only (check all that apply). O A Ir Conditioning
❑ Demolition (Interior non•atructural) ❑ Electrical Alteration (not change) O Gas Lighter p pea Log
❑ Heating Unit O Lawn Sprinkler O Mobile Home replacsment OrRoofing O Sewer Line O Ph volta►c
O Ventilation 0 Water Heater O Water Line 0 Wood/Pellet Stove (must be EPA certified, provide nake. model and �j
manAdufer). �IQ
Complete all applicable Information on the application. Incomplete applications will not be ae opftd
Application [096ffl Date o
For afce rage only
lob Site Addreq (revud) ValueofConsbuation (labor, ma als, profit)
G 7 2 "On 4- a i Ir el ,n S4 5 is C. • � � -
Property Owner Name Address Clty/Stage ZIP I Phone
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Applicant Name Address City/State Zip Phone
Contractor Uc # t2 21 Address CKY/State _ ZP Phone
Conttedcr City Of Ft. Collins Sales Tax # Are you paying taxed here or by report? M Here ❑ Report
S5121 p+rnr~11rie4aNed0yal/aw"Ca:rx Are you paying with your trtst account? es *No
Is this a residential or coffVwrd&i pro)eW IH�Residential 0 Commercial
If residential, is It, Single Family Detached 17 Ccndo/bownhome (single family attached) O
0 Multifamily (apartment) 13 Garage
If eomrnerdal, is IC O Bank O Bar C3 Church O Hotsl/Motei 0 Medical office 13 Office O fit
0 PAsti trant 13 Other (ex pdaiyr) need m c»ntaccN�eorlc f
Is this buUcing 50 ysare of ape or More? ❑ Yes LL�� No !1`Y P w r►�Y
If this is for a detnofltlon partrtlt, what year was the Wilding conatruc 0V
!1 pr& to 19n, y= wN/ need an asbrss anent to subrn/t w" tMs *p/Aatlan.
'If lawn sprtnitler ow prwenbu, must list licensed plumber. If first time A/C, must Iist Ilcertsed eiecxrloa�.
S.boonb scltbl VM UW cn WPOY name of Gn' arR LWIn-q &wnne I
oe&Kmn— .— Plumber
Mechanical Rooter Other
I hereby edo►owWp that I have read this application and state that the above Intbrmation is eompleW end Correaf baW" to a
comply wo all requirements contained herein and city ordinances and state taws regulating building conrtn+
Permit is not valid wo ft has been paid and Issu@&
Applkantr �J Signature
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