HomeMy WebLinkAbout815 Apex Dr - Applications/Reroof - 11/04/201111/04/2011 11:11 3039389642 BMROOFING PAGE 02/10
Fort Collins
of
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) C Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Wate, Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information cn the application. Incomplete applications will not be accepted,
Application # 61110123 Date Sn-56
For office use only
Job Site Address (regnuired) Value of Construction (labor, materials, profit)
'7S � � � 1 � t %� y ✓ �' $ (s o S fV q x ivo
Property Owner Name
Address City/State'/ T;
Zip �a-.S
Phone�'I J0
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Applicant Name
Address City/State
Zip
Phone%
Contractor
Lic #
Address City/State �.'i
iEr?ts
Zii' ((
Phone 31'33lb
g r e"Lj
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
�jReport
Sales tax number/srequiredbyal/rnndactnn
Are you paying with your trust account? ❑ Yes
Q No
Is this a residential or commercial project? 19, Residential ❑ Commercial
If residential, is it: ❑ Single Family Det iched ❑ Condo/townhome (single family attached) O 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? ❑ Yes IWNo If yes, you may need to contact Hlstorlc Preservation
If this is for a demolition permit, what y!ar was the building constructed?
If prior to 1R75, you w111 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed 'Plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license 0
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have 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 it has been paid and issued. 411
Applicant:
Print Name: tit ri�.v _ Signature
Date 11NLI