HomeMy WebLinkAbout7311 Silver Moon Ln - Applications/Reroof - 12/02/2011To: trom: Rsmey ULM ic-u3-11 o:iiam P. c oc 3
Planning, Development & Transportation
t::`i$ r: 281 N. College Ave P.O. Box 580
'Fort C Wns Fort Collins, CO 80524
-: Phone 970-416-2740 Fax 224-61.34
0WR-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 7- ,Air Conditioning
I-] Demolition (interior non-structural) ^ Electrical Alteration (not se ce change) 'D Gas Lighter Gas Log
C_I Heating Unit ElLawn Sprinkler ❑ Mobile Home replacement Roofing t: Sewer Line Photo-voliaic
� Ventilation bVater Heaterw. Water Line t'I Wood/Pellet Stove (must be EPA certified: provide maKe. Mud<: any!
Ij
manufacturer).
Complete all applicable information on the application. Inco;L mplete applications will not be accepted.
j� II 1 —
Application *_..._�' IDate
_v...__
or office use only — ....
)ob Site Address required)
� Value of Construction (labor, mate, ials, Profit)(
I � 00
... _ hone q70
Property ' Owner Name
Address City/S Zip
P
_- - _
Address City/State Zip ?hone
Applicant Nome co
tractor
Address City/State Zip Phone
Con
o.
Cortrador City of "r t. Collins Sales Tax Are you paying taxes here or by report? -lere epert
Sv1es tax numne. r, vir°C e' 1-0 1-dC'tofs Are you paying with yoc;r trust account? ❑Yes No
o � —_
Is this a residential or commercial, project'? Residential ❑ Commercial
f residential, is i,: )KSingie Famil Detached ❑ Condo/townhome (single family ati ached` ❑ Duplex
❑ multifarniiy (apartrient) ❑ Garage
1f cor mercial, s it: ❑ Bank ❑ Bar El Chu, ❑ Flotel/Motel ElMedicai office ❑ office ❑ Reiail
❑ Restaurant ❑ Other (explain).-..-..--...- . —
is this building So years of age or more? G Yes ---
No If yes, you may need to contact rfrs[)n'c P,rese!v<7tior,
i 'this is foi a demolition permit, what ,year was Nh b .�iidin constructed. _._.—......
9
1, pr;& to ,.9i5; you will need an asbestos assessment 10 s bmi[ with t.•tiis appllcalro;;.
Description of work ._
i
cif laver; sprinkler backflow preventer, must list licensed plumber. if first-time A;C, must list licensed electrician.
Subcontractors: ; ist the cmcahy nair7e or Gjv of FtCb%L`•^s i.%tense m
Mechanical_ Ro0!._ • �� Other_.. ;
-• . � __ Humber ., - __ .. .
t�i?reGy ackr'OWieOgl-' tll3�a •`1dVl' —ad - !.. 3�rilC�t on and state that the above info rmat!on +s complete aCd zoiieci, 1 391 J-
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comply 1Vitf ail requirements a) rtained hcreir; a^d c.lt✓ OrdlnanC'S and state laws r2gulati buii;;i: ; co.. uct:on, I know that z
permit is not valid until it has been paid and issued.
Applicant: Signature.-- Date. �. �.
lA��1 �V Vt6 i ture.-- —
Print Name._.._ - a! _—_.._ _