HomeMy WebLinkAbout2633 Black Fox Ct - Applications/Reroof - 11/28/2011FROM :kessler FAX NO. Nov.28 2011 10:28AM P1
Get of Planning, Development A Transportation
Fort Collins �COIJIM, CID 80524 N. College Ave P.O.
Box 5�
Phone 970-416-2740 Fax U"134
OVER-THE=COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). O Air Conditioning
O Demolition (interior non-structural) O Electrical Alteration (not service change) O Gas Lighter O Gas log
❑ Heating Unit ULawn Sprinkler 13 Mobile Home reo' so —it XRooting ❑ Sewer Line ❑ Photo -voltaic
O Ventilation ❑ Water Heater ❑ Water Line 13 Wood/Pedlst Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable mnation the application. Incomplete applications will not be opted.
Application # t` °b-� ate ltb e
Foronke u� 150.5e�
Sob Ske Address (Amp*ed) Value of Constniction (labor, materwri, poont)
2tc,93 1:kla,l<P^„ rf $ 49IIn 490
Property Owner Name Address
city/state Zip Phone
2653 81a,&
fe G Sos2ro 221-4000
Applicant Name Address
City/SYate Zip Phone
Contactor Uc #AA2.2!? Address
citY/State Zip Phone
XESSL Ak,40 09%46- 628 V/C7XetitZ/A XW., AM Co LVVC.NW (97b
Contractor City of Ft. Collins Sales Tax #
Are you paying taooes here or by report? O Here XAeport
Sa/es��� by so MOM=
Are you paying WWI Your trust account? XYes O No
Is this a residential or commercial project? A Residential O Commercial
If residential, Is It. Single Family Detacthed ❑ Condo/bownhome (si gie family adached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar O church O How/Motel .O MediQd oflkoe O office, ❑ Retail
O Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes )Sf No 1fy, you maynesed m mntatt H Prusvvaelmr
If this Is for a demolition permit, what year was the building constructed?
IfPdar to 1975, Wu wl# need an asbes aaewnwt to a,*p l w/Ci dw appkcaLlon.
Description of work
*If lawn sprinkier/backllow p►eventer, must list rrcensed plumber. If first-time A/C, must list licensed elan.
Subcontractors: Ust UW cwnpcanynaine Of QYOfRCbl#as/karjse 0
Elecoidan Dlurnber. M Roofer Q_2 Other
I hereby acknowledge that I have read this application and stage that the above information is complete and correct I agree to
comply with all requirements contained herein and city ordinances and stage Was regulating building consbvctiorh. I know that a
Permit is not valid until It has been paid and houed.
Applicant: tt
Print Name u _Grister s owtrtrs