HomeMy WebLinkAbout1333 Nassau Way - Applications/Reroof - 11/29/2011City of Planning. Development a Transportation
281 N. College Ave P.O. Box 580
/ F6,.} t Coltins Fort Collins, CO 80524 1:ftl-03
Phone 97"16-2740 Fax 224-6134
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 4'.Roofin_ g ❑ 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.
Application # Ili l D'� 3 3
For office we only
Incomplete applications will of be accepted.
Date W 1 a
Sob Site Address (required)
E UP v ry
1333
Value of Construction (tabor, materials, profit) 177o —
11/ f�� F� 6//,' ��S"z5 5'�I--392,?
Property O Name
Address
City/stawz Zip Phone
Applicant Name
Address
City/State Zip Phone
Contractor i1�
I- k00r/h - 13,60 J•
1AAdd s
�" NG %l'Y(Jr�
b 7//City/State / !/� Zip ?6 z 32. Phone '170
I} [ x :z0z (�h4'P Poc (-O 127 ^L (l
Contractor City of . Collins Sales Tax #
sales tax number isrequfiedbyall mnrraclace
Are you paying faxes here or by report? 1 Here ❑ Report
Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? WResidential ❑ Commercial
If residential, is it: G3'Single Family Detached ❑ Condo/tormhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
■ ' 3r.
❑ Restaurant ❑ Other (e)plain)
Is this building 50 years of age or more? ❑ Yes 1X No If yes, you may need to conbct Historic Presawbon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbesfus assessment to submit with tfits aAol/calion.
Description of work uL r hur h s P& kv..-
*If lawn sprinlder/baddiow preventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or Cty of Ft Collins Axonse # G�
Electrician Plumber Mechaniol Roofer �� v a I 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 contalned herein and city ordinances and stale laws regulating building eonswxbon. I know that a
permit is not valid until it has been paid and issued.
Prrii t Na Fo f esr 0 D otVM 6 t Signature �abe