HomeMy WebLinkAbout1207 Leawood St - Applications/Reroof - 11/14/2011201W-14 14:22 Pinnacle Roofing
8772389205 >> 970 224 6134 P 2/3
Fort Collins
Planning, Development & Trdn",ortablon
201 N. College Ave P.O. Box 580
Fort COMM, m 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). O Air Condition ling
Demolition (interior non-structural) O Electrical Alteration (not service change) 0 Gas Lighter O Gas Log
O Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooting ❑ Sewer Une ❑ Photo -voltaic
❑ Water Heater 0 Wow Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, modal and
0 Ventilation
manufacturer).
Complete all applicable Information on the application-
Application * EI I I 0 513
For of a raw cry
Sob Site Address (m4wmd)
Property Owner Name Address
Applicant Name Address
CoMI -J Address
Incomplete applications will not be accepted.
o� 155.13 _..-
Value of Conshvetion (labor, materials, PmWj
N-�A
Tip Phont
�Y/5t�
Gty/5t3te ZIP PhOm`
City/State Zip Phone:
Contractor CO of Ft. Collins Sales Tax # Are you paying hem or by repot? Is?'flere ❑ ; 4rt
yaks tirnw,+t>anerAmed raraam�e� ►ara
Are you paying with yw trust account? ❑ Yes ❑ iV0
Is this a residential or�n merdal Protect? i iesidartfal O ConumCial
Wm (single family atladred) O Duplex
If residential, is IE 9" ngie Fartely Detached O Conde/town
O Multifamily (aperhnorrt) ❑ GaraW O Medical office ❑Office O Retail
If conmeodai, is it: O Bank Bar O Church ❑ Hotel/Motel
O R+esfaura t O Odw (exp 1pa
Is this building 50 years of age or more? [3 YesEyNo r.M Yw may need dv mnface Histm* Pbesrery Hm
if this is for a demoMon pennft, what year was the building COnst[I
iar Q7 1975, ycxi *Y# need an a assessment to subrro ow7/r d►ts ap
!f ppllra&n
Description of work
'If lawn sprinkler/baddlow txc%e�, must ast fimn9ed plumber. If flrst time AIC, meat 1'esb Baense� electrician-
*if
List fhe aMmW name ar CIFY 0M bB7is dfcamm ?
�r�iioaarL.. PAxreber r7edrervtimL Roofer Other —
I hereby adwwla� that I have read this appllotlon and slate that the above MMITTlatim is complete ana axrea
comply w1th all requtremeM contained II and city ordinance and state laws regulating building eonstrudion- I krsci#+lthat a
permit is not valid until R has been paid and lssued-
Applicant
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