HomeMy WebLinkAbout1314 Village Park Ct - Applications/Reroof - 10/24/2011Oc:c`•?4 2011 6:59AM HP LASERJET FAX
City of
f"t CO(iIr1S
OVER
p.5
N.
Planning,
281 Development A Transpoitittion
81 NN. College Ave P.O. Box Sao
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
-THE-COUNTER PERMITS ONLY 17 LS
Thisa"lcstlon Is to Ica, used to apply for the following
O Demg"On (Intfrior non-structural)ti parmits only (cheek sell that a I
D Healing Unit ❑ lawn Sprinkler O Mobl�Home rep apemen s ['pe change) ❑peg 1plghte��� 1 cGas �vonlny
❑ Ventilation D Water Heater D Water Line O Woodlace t Stove (moat De EPA Sewer
U e 0 Photo•voltalc manufacturer). , Provide make, model and
Aomdleld all applicable ,0 0j latl I
aaoil�aaon # on the application, Inopmplate applloatlene will not be uacepted,
� Lp paw 10 l,7Ljl ,I IaS.bS
3ob site Address p e;u&W)
r2 t[J t n n . . Nil
Property Owner Name
Applicant Name
Address
Address
UC # R7,11 V Address
Contractor City of FL Collins Sales Tax
soles mrae0estr del;aN/mrrtrac�rs
Value or Coeatruatlort (labor, matrisials, proeq
$
aN/state
oN/state
City/state
Zip
ZIP
Zip Phone
L 3000
Are you Paying taxes here or by report? M Here O Report
Are you paying with your trust account? U%$ ti No
Is this a residential or__co�m erctal project? Residential D Commercial
If residential, Is it: Eningle Family Detached ❑ Condo/townhorne (single family attached) O Duplex
IJ mily (aParUnent) 0 Garage
If commercial, Is it: Banks D 13 Bar 113 Church p Hotel/
Hotd/ Motd El office O Office❑ Retell
D Restaurant ❑
ild SO Other (explain)
Is this bu
�9 yaats of age or morel ❑es o No
If this is for a damelltJan pannit, what year was the building constructed?
lrpnbr to 1975, ytw w/// Meld an dtsbBstrrs assiesoent to mhm/t wgyr this eop✓kebba
Description of work
..
*If lawn eprinWer/badQlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Suboonbuctom: List the company name or C7ry of Col/Ins ffewtse ,d
EfectridwL. PIumOO Mecharkal gpofef
Other
I hereby adotowiedge that I have read this eppllCation and state that the above Intbrmetion is complete and correct. I agree to
comply with all neciulrementr, contained herein and city ordinances and Mate laws rmgulating building construction, I know that a
Permit Is not valid until It has been paid and Iceued.
Applieanb
Print Name: Signature