HomeMy WebLinkAbout311 Alpert Ave - Applications/Reroof - 04/22/2014Apr 22 14 09:58a Tony
1-970-669-5999 p.3
F6City. Of Planning. Development & Transportation
t Collins 281 N. College Ave P.O. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to aPPIY for the follows
ll that
D Demolition (interior non-structural) D Electrical Alteration (�ms�rvice change) only (check aD Gas Lighter 0 Conditioning
❑ Heating Unit ❑Lawn Sprinkler D Mobile Home replacement ❑ Roofing D Sewer Line 0 Photo -voltaic
D Ventilation ❑ Water }der p Water Line ❑ Woodipellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #14.0 I q "7 Date
Far offm use of*
Sob Site Address (required)• Value off
3 suction (labor, materials, profit)
G ,�e .
Property Owner Name p Phoned
Address City/State Z
.
<
Applicant Name D Otis 5 '? g - L3 (4eP
Address City/State Zip Phone
Contractor Address Gty/State (pV� 10.N�Zip Phase
n 330 N 1/nrt�tn#�I $U�3� 44a
Contractor City of Ft Collioc c ram,. /nq�� q49
Are you pantaxes h
saiestaxnwt&-Lg ybyayow� Paying xes ere or by report? klere D Report
Are you paying with your trust account? VLYes El No
Is this a residential or commercial project? W4Wsidentiai ❑ Commercial
If residential, is it: II0,Single Family Detached ❑ Condo/tovmhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑Office ❑Retail El Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes ❑ No jf yam, yW ma,need to ciaobcr Hlstp yc
If this is for a demolition Permit, what year was the building constructed?
Ifpr/or to 1975, You wi// need an azessment to submit wffi th s app/station
of work
*If lawn sprinkler/backflow preven6er, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: W tyre ewn/aany name or 6ty of CcJtirAs /icpns>° 0
Electrician Plumber Mefiarimi
Roofer Other
I hereby admow&�cke that I have read this application and state that the above irdaMation is oamplete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws reguWng bulklin oonsbv
Permit is not valid until it has been Paid and Issued. 9 ction. I know that a
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