HomeMy WebLinkAbout1009 W Oak St - Applications/Reroof - 10/21/2011F . . Planning, Det will t & Trdnspoltatllon
wort Collins 281 N. College Ave P,O, Box Sao
�� Fort Collins, CO 80524
Phone 970-416-7-740 Fax 224-61,14
OVER-THE=COUNTER PERMITS ONLY
This application Is to be used to apply for the #allowing permits only (check all that apply), C1 Air Conditioning
❑ Demolition (interior non-structural) p Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 11 Lawn Sprinkler ❑ Mobile Horne replacement O Roofing O Sewer Line ❑ Photo -voltaic
0 Ventilation 0 Water Heater ❑ Water Line Q Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Compute all applicable Information on the application. Incomplete applications will not be accepted.
Application * f > l8 V 1 ,27 V Date 10 - )4 - 1 ( (� 310
For otf9te use only
Job SMS Address (rwurred) Value of Construction (labor, materials, prottt)
Property owner Name
Address •
city/State 23p
Phone
O e <4 f- Oa
+
cal (jAS) Co 05a.(
—
Appllcant Name
Address
. City/State ZIP
Phone
7—je(-cli WiAn lS
.4 Si
ovdand_ C2 905-37
7-I26'f
ContlaMr Lic #
Address
city/State Zip
Phone
Cmat cbor Csty of Ft tollins Sales Tax #
Are you paying taxes here or by report?
lb Here ❑ Report
gsiutwnrenber&iMurred@ya/lcanbadws
Are you paying with your trust account?
Cl Yes No
Is this a residential or commercial projed? Q4 Residential C1 commercial ❑Duplex
If residential, is it 0 Single FamilyDetached ❑ Condo/ townhome (single family attadted)
0 Multifamily (apartment) ❑ Garage
if commercial, is it: ❑ Bank ❑liar ❑ Chumh ❑ Hanel/Motel L7 Medico) office I� owe ❑ Retail
❑ Restaurant O Other (explain)
Is this building SO years of age or more? 0 Yes Cd No If ye-. you may need tO'Con&mtN/Sz7xfc Jt soon
If this is for a demoiWon permit, what year was the building constructed?
lJrnrfar to 1975, you w#1 need an asbestos anent to submit waft this APOCabb
work
*If lawn 5prinfder/bacow preventer, must list licensed plumber. If first-time A/C, must list licensed elec ian•
List bite company name or QZY of Ft Cal/Nrs /icerrse
Otter.
emdridan_____�
Vlu nber Mechice-- -
ication and state that the above information is cornplette and port eCt. I agree to
I Eby acknowledge that I have read this appl build construmon. S know that a�
comply with all requirsn�"b cantainad herein and and ��-nanceS and state fawn regulating ng
PeMit is not vHtid unto it has bean pa
id
ApplICArtt: Ct� !t 1� 1
print Name:�E' ( 1,A 5lgneturo