HomeMy WebLinkAbout2600 Parklake Dr - Applications/Reroof - 06/23/2014Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F01r t Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ® Roofing ❑ Sewer Line ❑ Photo -voltaic "
❑ Ventilation ❑ Water Heater ❑ 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 # �`� C� Date CO r;�J
For ofte use only
lob Site Address (required) Value of Construction (labor, materials, profit) .
P -
Property Owner Name Address "
City/State Tip
Phone
6o
co $o- W,5
Applicant Name Address
City/State Tip
Phone
�rHviD FEA; pow 73� .s�i�
Liu c.r.u� o
Contractor Lic # Address
City/State Zip
Phone
�e AeA C2 65
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
® Here ❑ Report
Saks tax number Isfegdredbyall av&acft
Are you paying with your bust account?
® Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes IN No If yes, you may need to contact Hislvric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Desa•iption of work
*If lawn sprinkler/badAiow pneventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: & Me company name of Cty offt Collins license #
Electridan Plumber Mechanical Roofer 6 F;aa z q Other
hereby acknowledge that I have read this application and state that the above information is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I brow that a
permit Is not valid until it has been paid and issued.
Applicant:
Print Name: DQ��� �8,#ra��.:ts, y Signature�Date •G�Ali/rs