HomeMy WebLinkAbout225 Maple St - Applications/Reroof - 10/04/2011 (2)City of Planning, Development & Transportation
o C' 281 N. College Ave P.O. Box 580
ollins Fort Collins, CO 80524
/r`��od�"'�•� Phone ,970-416-2740 Fax 224-6134
OVER-THIE-COUNTER PERIVI'M ONLY
This application Is to be used to apply for the following permits only (check all, that apply). ❑ Air Conditioning
❑ Demolition (interior non-structuran !❑ Electrical. Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoofing ❑"Sewer Line . ❑ Photo -voltaic
0 Ventilation ❑ Water Heater ❑ Water Line ❑ WoodtPellet'Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableinformation on the application. Incomplete applications will not be accepted:
Application # �. ` �� S�'Y Date
Aorofte use only
Sob Site Address (requil ed)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
Cif oqF R. C'ol ins PO' 06x 580
E�,(10Itins C6 905;-Z?
0-221-653
Appl cant Name. Address
City/State 'tip
Phone
:Ted` "T-OK Avc- Ove-( K&0 CD $0559
06 7 9 Q0
Contractor Address
City/State Zip
Phone
rJ R006, S s vns t�
1( ' ft .
A
Contractor City of Ft. Collns Sales Tax #
Are you paying taxes hereorby report?,-
--Bf eport
saes tax n reQurred by alp crno-actcr�
u paying with. your trust account
Ar;90 -P ce s -- .' o b i s �►- Ci
off' -F�-, C'®I'I i v� s
Is this a residential' or commercial project? ❑
If residential, Is It: ❑ Single Family Detached
❑ Multifamily (apartment).
Residential 10 Commercial
0 Condo/townhome (single family attached) ❑ Duplex
0 Garage
If commercial, is it: ❑ Bank ❑ Bar 17 Church O' Hotel/Motel 0 Medical office .❑ Office ,❑ Retall'
❑` Restaurant ,Other (explain)
Is, this building 50 years of age or more?' O Yes ❑' No If yes, you may need to contactHlstorlc Pmwimatlon
If this is fora demolition permit, what year was the building constructed?
Ifprior to 1975, you rvllLneed an asbestos assessment -to submit *0 th1s,appllcabbn.
'Description of wor eo-P 4 ea r - 6# . / 1 Sol vca re. s
*If lawn sprinkler/,backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company nane,or Oily of ft Cblllns llcense ►# 2 2
Wedridan Plumber Mechanical Roofer, R-- 77 other
i'hereby acknowledge that I haver 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 Whas been.paid and issued.
r
Applicant: L
Print Name: ►'"S �/n f ' ✓✓ Signature - Date i.t