HomeMy WebLinkAbout7324 Silver Moon Ln - Applications/Reroof - 10/31/2011Cit
of
F®r�t Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement �4 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ 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 # B I w 1cl 9 Date 10.31.
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
rl324 Sifve2 OOM �Am
1454boo.00
Property Owner Name Address
City/State Zip Phone
W1 QQgjo, Ue, TVA Si1Ve,409M l,n- -7. WWIS �-0595 (A7rp a8a.9a9
Applicant Name Address
City/State Zip Phone
s 1 vl n 495r7 n
DAM pat. Co 303 3� Doi
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? `Here ❑ Report
sales ax number Is required by,711Wntradois.
Are you paying with your trust account? 6 Yes N00
5br74,D
Is this a residential or commercial project? Residential L] Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office [3 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the'building constructed?
Ifpiior to 1975, you will need an asbestos assessment to submit with this application.
*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 #
Electrician Plumber Mechanical Roofer . Oi 1 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.. .
Applicant: o ' I rrm
Print Name: SW) n Signature Date
c