HomeMy WebLinkAbout5321 Golden Willow Dr - Applications/Reroof - 10/21/2011City r,', Planning, Development & Transportation
�^�., 281 N. College Ave P.O. Box 580
Coll
,. ��� ins Fort Collins, CC 80524
N4 Phone 970-416-2740 Fax 224 6134
This application is to be used to apply for the following permits only (check all that apply). !fir Conditinniny
❑ Demolition (interior non-structural) F..lectricai .Alteration. (not service change;i E Gas Ligh(er !::i Gas Log
I Healir•g Unit a Lavin Sprinkler ❑ iNlobile Home replacernmil ` Roofing O Sewer Line ❑ Photo-voit iic
�! Ventilation iNater Healer L- Water Line � Wood/Pellet Stove (must be EPA certciec, provide ma-m, model and
manufacturer!.
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #— I �� 5U Date _-_( . 21 . I • SS
of office use nr(!v
Job Site Address ;iequlleo,: Value of Construction 'labor, rra;eriais, prof,!
_..._�
Property Owner Name Address City/State T• Phone
Applicant Name
�
Address o tyi5ta[e 7il P' one i
C 02t TI ...il;.
ontra +or
_I
Address City./State Z;i% PFtone
Conti actor Cety of Ft. CAI I. is ,a! s Tax = Are you paying taxes here or D'y reoor,J 15CHel e i Report
Salecfdx nl.n.fr,+r S ^equh^d tir al.;?ntr,.C-ors. X No
Are. CU paying with 'Oli' t�, °t .- — c
Is this a residential or rummercial proje( Resi *? de:^.tia❑ommerc
l Cial
\
If residential, is it: b Single Fan;i!'y Detached ❑ Ccndoltown"nip !single family attaril;,dj ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerna:, !s it: O Bank ❑ Bar ❑ hurch G betel/Motel ❑ Medicai office n O`.'icc R i
- ❑ C 21'i
El Restaurant ❑ other explain)
Is 'his building 50 years of age or mere' ❑ yes �hn ;/Yes ; (, ^L 7! , i .J n'J/; :';/51 ; IC (c r;•3 %J/'
If this is for a demolition permit What year was the buiiding consLruc[ed7
If prior to 1975; --- -- -----.... -- —
/O(i will neP.(� If? ashostos assessmen! to s: vnit With th) s nppi/cati(.^,,
Description o/ work T� �x �__04,1C r t • -1 a-1
ii 1];lYl It1f�J_el;, Ll I_.iV1'uL'n�_ LL
i' lawn Sp•mXhr,'! ckflow orrventei n i5t list iirei!ctrl plumb r. If f is[ hrn.• /1,C, mu:; li,: lir.nsed el r'ii�;an.
Subcontractors:st the (er pan; r rme n/ r:/!y _ Ft Col%m Giense -
p n
Electrician Vl::ae�cr ....-__—.. .... Mechanical
— •---- —
f hereby aeknowle ge that I have rear this apclinl on and state ' hat the alho e i `c -r;:Con �
Comply iSiYti all r._au.rr-mans contained herein and ct xdinanas nd Stan saws �� ,e [JreC ,lyre^ o
Y ' a ; IfaU.^.g ,.,e,.. y :o- al. f �':. I know that a
permit is not validuntilit has been paid and issued.
Applicant: r / Print Name:__--.'�Paf—ice v� Signature.— P�
-- . --- -- . - Date .l V