HomeMy WebLinkAbout3113 Appaloosa Ct - Applications/Reroof - 04/14/2014�i$C3Yr Planning, Development &Transportation
y 281 N: College Ave P.O. Box S80
f
•�.__>t1;:s�:t.E: Fort Collins, CO 80524
Phone 970-416-2740 Fax 229-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (notservice change) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement )d Roofing ❑ Sewer Line ❑ Photo voltaic
❑ Ventilation ❑ Water Healer ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application Date
For offlce use only
Job Site Address (Wuired)
Value of Construction (labor, materials, profit)
311 3 A od a C_-E-
4 1 qcc-� . oc-�)
Property Owner Name Address
City/State Zip
Phone R7C-�
an8-!cam
Applicant Name Address
Clty/State Zip
Phone q 76 -
ia-F <-AotioLe 2 oo-e = Inc . a t'l
tW. 1?-X EM C6 $OSa S
�to?-a6o o
Contracto,,r Address
ty/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? �' ❑ Report
sale: taxnumberisrepuded bya// conimaws.
Are you paying with your trust account? ®'Ves
❑ No
Is this a residential or commercial project? , flf Residential 0 Commercial
If residential, is it: ® Single Family Detached ❑ Condo/hownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? 0 Yes ❑ No If yes, you may need to confactHisladc PreservaL'on
If this is for a demolition permit, what year was the -building constructed? -
If poor to 1975, yoq will need an asbestos assessment to submit with thls app/icaflon.
Description of work. m� A-- rQ e: ' s-Ih
' S'
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must fist licensed electrician.
Subcontractors: i./st d7e comvany name or CRY Of Corns //tense 9..
Plumber Merhantot Roofer R— ISSy other
Bectridar
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
state laws regulating building construction. I know that a
comply with all requirements contained herein and city ordinances and
permit is not valid until it has been paid and. Issued.
r
Applicant: `•r`1•.�' i Date
'vv< �E � i S Signature
PrintNeme• ` J i�
_i`