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HomeMy WebLinkAbout1244 Dewey Dr - Applications/Reroof - 12/16/2011Dec 1G 2011 5:558M HP LRSERJET FAX p.1 NOf Collins 2ai planrNng, Deyalopn�ent N& Tnmspo�tion col. lege Ave P.O, t3ox S80 Fort Collins, CO a0524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER P �y Thla app'kWbn Is to be used to a ��t ONLY O Demoggon (inferior non-etructurel� apply r �° following P�rthka pn � Heating Unit D L+twn 3 Sprinkler q eotrical Alteration ��Hheok all that apply), p Air Conditioning P Mobile Home replacemenn 8RRoUngng) a alas �I (3 o o-y iLOU alc ❑ Ventilation ❑ Water Heater O Water Line ❑ Wood/pellet Stove (Must o sewer Lin® ©Photo -voltaic ( ust be EPA c6ftifled, provide make, model and Com01*18 all applicable lnf n4atr.... ,.- Application * Fier o* u asnlyanly sob Slts Address (ice) Property Owner Name Applicant Name Contractor the appllcetlon. Incomplete Address Address Uc #Z� i6 Address Contractor City of Ft, Collins Sales Tax # s oum#vd&trn�4u►h,day�ic�, a,,x •PPIlcgtlona will not accepted. aat e Vilna of ConstruCtlOn (labor, materials, profit) Joao _ 0C-) CCity/State City/State City/State von l 1P, ZIP Phone 0 2' Zip Phone ZIP Phone Are you paylnb taxes here or by report? M Here Ci Report Are you paying with your trust account? p Yes Ck No is this a restdenttal or �T�p'�nn�eerdal project? Residential O Commercial R If residential, is It: ff Singfe Family Detached ❑ Condo/townhome (single famil attach ❑ Muhlfarntly (apartment) Ci Garage y ed) ❑Duplex If commercial, Is it: ❑ Bank Q gar ❑ Church ❑ Hotel/Motiel ❑ Medical office ❑ Omce ❑ Retail L7 Resturant d Other (explain) Is this building SO ywrs of Ma or morel O Yes G No If If this IS for a demolition par 1 It what year was the building con,�cteMay new m Pn Nae�n Ifp>or 01974 ypu w/0need an asMRbs amiw&to Jut"* w16 this 4Wh1rdpba of work *If lawn sprInkler/backflow preventer, must list licensed plumber. If first-time AM, must list licensed electrician. Subeontnaetom Lit Me cwPmy name or aty omt Col#ns &wme 0 Electrician— Plumber Mechanlca Roofer Other _ I hereby acknowledge that 1 have read this application and state that the above. information Is cornplete and correct. I agree to comply with all requirements contained herein and dry ordinances and state laws regulating building construction, I know that s permit Is not valid until It has been Paid and Issued. Appllce"*b Print Nanfe. ,� signature Date