HomeMy WebLinkAbout2718 Brookwood Dr - Applications/Reroof - 12/15/201110: trom: Ashley 11CLain 11-15-11 11:1jpm P., I of I
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Planning, Development &Transportation
I. N. College Ave P-0. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
'. D
Demolition !interior non-structural) 17J Electrical Alteration (not se change) 17Gas Lighter Gas Log
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0 Heating Uni, 0 Lawn Sprinkler U Nlobile Home replacement RRoofing 0 Sewer Line
Photo -voltaic
VentilationWater Heater 7— Water Line L
Wood,'Peilct Stove (must be EPA certified. provide make. riodei and
manufacturer;.
Complete all applicable information on the application, incomplete applications will not be accepted.
Application it Date
For office use only
Job Site Address (requil-ca) Value of Construction (labor, materials, profit..
. .......... . ...... . . ......
Property Owner Name Address City/State i Z'! p Phone
P. "I% -A
A pp! i c a rif N a rn e
Zip Phone
Address City/State
^1L. Co 82-D4 3, n 614
Cwq n 2f? 10 tO. ISK RX, DMV t
Contractor Address City/State Zip '%r Phone 1
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Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ere
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Are you paying with your trust account? Y )<No
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L mal a Ct�a01.5.
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Is this a residential or,commerCial project? "PRes:denrial D Cornmerrial
If residential, is it 06ingie Farniiy Detached 0 Cendo/townhorne (single family atta0ed) 0 DIL1010C
0 Multifamily (apartment) 0 Garage
C If commercial, is it: 0 Bank [I Bar0 Church D Hotel/Motel 0 Medical office 0 Office [2 Retail
C1 Restaurant 0 Other 'explain)
o if yes, you rnay.17eed tO contactH6.'*1'),-i(_
Is this building 50 years of age or more? 0 Yes
11 this is for a demolition permit, what year was thk bNding constructed?
"-Xial' to j you will need an aste5tos assessment Lo s.,.ibmil with this applici,,fiao
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Descciption of
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work OFF
r1d., T
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lawn prink!eribackflow oieveriter, must list licensed plumber. If first-time AIC, must list licensed electrician.
subcontractors: tisr rho company nafne or C;,'v off r Collins i1cMS0 ri
Pi::mber 14echa.lical R cofer ......... .......
hereby acknowle ge Lt`at i have read this application and state that the above 4-forniaton is cornl�!ete and :,orre(ft. ilgre- Lo
i
carridv with ail requirements contained nereir and city ordinances and state laws re; matt bt leis coast -uction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Date I
Print Name: Signature .._4