HomeMy WebLinkAbout1519 Buttonwood Dr - Applications/Reroof - 10/11/2011City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6rt Collins Fort Collins, CO 80524
`.., Phone 970-416-2740 Fax 22+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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement IX 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.
fo
Application # )A� k � M ate
f For oce use only L4a�
Job Site Address (required)
Value of Construction (labor, materials, profit)
l St 0* 1 rl `1) r-
r-f - Co ffw,� 5-25
Sol - C/-
Property Owner Name Address
City/State Zip
Phone
1
& .JctP. � Ac'r1e(C t al
i-AeMznr -P Pc tf.edIw3 dD
oPz 4/c
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
'(Yi (TC- SYtc N . GY of zELO Uj'*LgNo gOSM'
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
® Here ❑ Report
sales tax number is required by all contactors.
Are you paying with your trust account?
® Yes ❑ No
ys13cl
Is this a residential or commercial project? ® Residential ❑ 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 ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 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?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
2 Q ua2ET,
*If lawn sprinkler/bacldiow 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 R— I s / 0 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: R6b �_ �a
Print Name: C'+ '\2C SignatureDate lo— ((� I
ac�G7