HomeMy WebLinkAbout1302 Village Park Ct - Applications/Reroof - 10/24/2011OctS 0.4 2011 6:59AM HP LASERJET FAX
P.6
Planning, Uevolopment a Transportation
Collins 281 N. College Ave P O. Boxs60
Fort Collins, CO 80524
Phone 970.416-274o Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY FH3
Thle applleetion is to be Yeed to apply for the following * Demolition (Interior non-etruohuatJ ❑ EI O faerltdts only (-hock all that apply). O Air CondfMoning
❑ Heating Urni I7 Lamm g H Mobile
Hal Alteration (not a e age) O Gas Lighter O Gas Log
P nklor O Mobile Morrie replacement oofing C) Sewer Line ❑ Photo-voliale
E7 Ventilatlon O Water Heater p Water Line O WOOd/Pellet Stove (must be EPA Certifled, provide make, model and
manufacturer),
Complete ell spplkabfe IMomlation on the applleation.
MOofllpleto appikatlons will not be •oaepted.
Application # SI I oc1F pate 014, �S
Ftiv o/iktr rose oMy
JoD sit O Addrm (iwWked) Value of Construction (labor, mabwlmis, pront)
tiag� re. e,+ $ d 3
Property Owner Name Address city/stage h e
1 L/ ZIP P
Applicant Name CO.05 3p0f�
Address City/Stab- ZIP Phone
Contractor LIC # R Z I (g Address City/State 21p Phone
C4rltracrCity aof FL Collins Sales Tax # Are you paying taxes here or by report? is Here fJ Report
r°q"n°d�'ai'�"10 .NlA Cam.. --i Are you paying with your bug account? des III No
1..\ tr
Is this a residential or commercial project? fB�Residentlal O Commen:lal
If residential, Is it: 121tingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
O MultlfamNy (apartment) ❑ Garage
If commercial, Is It: O Bank 0 ear E3 Church ❑ hotel/Motel O Medical office ❑ offece ❑ Retail
E1 Restaurant ❑ Other (explain)
Is this bulkling 50 YUM of age or more? ci Yes ❑ No 11'yes; ytw may need lb cuntartH/st»de arsnnannn
If tills Is for a demolition permit, what year was the building constructed
If prfor to 19751you wN/ need en asbaslDs assessment to subnul' mm #* ap0/kvfr0A
Description of work - o �Q_ � ��_ p r l i Cp lxn
*If lawn sprinWer/badQiow preventer, must list licensed plumber. If nrst-time A/C, must list licensed electrician,
9uboorttr4ct0M L& lire Carrpsny navne or Gty of At Cafts hMmm I'
Sedrldan Plumber Mechanical. Roofer _ other
I hereby acknowledge that I have reed this applkatlon and state that the above Infbrmetion is complete and correct. I agree to
comply with all rVqulremerds contained herein and City ordinances and state laws regulating building Construction, I know that a
permit Is not valid until it ham been paid and Issued.
Applleenti
Print Name: &.t ZO&I 'n signature Daft V/-7ff `�