HomeMy WebLinkAbout520 Kim Dr - Applications/Reroof - 10/31/2011Oct 31 11 10:52a Shaughnessy Contracting 623-939-6077 p.2
Planning, Devetopment & Transportation
O� 281 N. College Ave P.O. Box 580
city 80524
Fort coffins Fort Collins, CO
Phone 970-416-27402740 Fax 224-6134
OVER.THE.COUNTER PERMITS ONLYhat Air Conditioning
This application is to be used to apply for the following permits only (check all❑tGas Lighter ❑ Gas Log
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change)
cofing ❑ Sewer
❑ pro
make, model and
Heating Unit ❑ Lawn Sprinkler ❑Mobile Home replacement Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet S ove ust be EPA certified, p .
manufacturer).
rnrnnrete all applicable information on the application. incomplete applications will not be accepted
Application #
For office use only
lob Site Address (required)
Property Owner Name
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Applicant Name
Contractor
Date-
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Value of construction (labor, materials, profit
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Address4.1 City/State Zip Phone
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City/State Zip
Address
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Address
City/State Zip
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Phone,c3-7c,-9P --�'
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Are you paying taxes here or by report? ❑ Here ❑ Report
Contractor City of Ft. Collins Sales Tax #
Salestaxnumberisrequiredbyallmnbacrors. Are you paying with your trust account? Q Yes ONO
Is this a residential or commercial project? <G-Residential ❑ Commercial ❑ Duplex
If residential, is it: 'p-single Family Detached ❑ Condo/townhome (single family attached) p
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office O Office O Retail
❑ Restaurant ❑ other (explain) need to contact Historic Preservation
Is this building 50 years of age or more? ❑ Yes �No lfyes, YOU may
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 app.iicaton.
Description of work
*If Worn 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
Mechanical Roofer Other
Elecuician . Plumber.
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, Date w 2 t
Print Name: ? lr 5LEV Signature CI awl --