HomeMy WebLinkAbout1478 Front Nine Dr - Applications/Reroof - 10/07/2011a-07-11;11:36 ;From:rtn roofing
To:2246134 ;9705931119 # 1/ 1
City of
Fit Collins
Planning, Development & Transportation
281 N. College'Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Cl Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical. Alteration (not service change) ❑ Gas lighter ❑ Gas Log
❑ Heating Unit D Lawn Sprinkler ❑ Mobile Home replacement gRoofing ❑ Sewer Line. ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 17 Wood/Pellet Stove (must'be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 6 110 o (100 Date / 0 / �7 r (/ 9 � . 95
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1qS Gaon-il- / i'Ae-
Pr. Goo, o0
Property Owner Name
Address Gty/State Zip Phone
/14Gtr1'o Sar(Abtl(o
75 F--t&vlliI1 6) Bo_';�5 9l0- qLI
Applicant Name
Address City/state Zip Phone
;reff' j_ozovt 55954
Locici--e� AVS LOve,6L OC CO $a 559 706 ' 7-I (Oo
Contractor
Address City/State Zip Phone
(t
ICl tJ ROCP iA ; la_
fl n rL
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? %Here ❑ Report
_sales tax number Ismquiredby0contactors. Are you paying with your trust account? O Yes No
Is this a residential or commercial project? gResidentlal ❑ Commercial
If residential, is It: DESingle Family Detached ❑ Condo/townh6me (single family attached) ` ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? CI'Yes )E No If yes, you may need to contact H/storIc Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to subm/t with thls appllcaVon.
Description of work of 2 a ✓'e �� c� of ro oZ6
o-
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or G'ty of Ft Coffins license #
Electriclan Plumber Mechanical Roofer f D7 Other
I hereby acknowledge that I have read this apprication 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 it has been paid and issued.
Applicant: //��Lk�
Print Name:11YiJ nn�Si n /' C/�n 46r- Signature Date