HomeMy WebLinkAbout2236 W Stuart St - Applications/Reroof - 04/02/2014Planning,. Development & Transportation
City. 281 N. College Ave P.O. Box 580
�OI � 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 XRoofing ❑ 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 # 51'P0i5Zq. Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
22-36 A/ 51t;
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Property Owner Name Address
City/State . Zip Phone 197C
,57/ f ^h-ti ek 223& l✓, 5&4ae4
.514 Peril- Lo/line C-0
Applicant Name Address
City/State Zip Phone
Tin h/i%tc>/
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Contractor Address City/ fate Z' Phone cl717
P%t zi 5e t rui yar► 73 5- 6*,�g r,� �L ��• Wi�506 tv -7
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
Sales tar number is required bya0mn"ctors
Are you paying with your trust account? ❑ Yes No
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Is this a residential or commercial project? R'Residential ❑ Commercial
If residential, is it: KJ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) f9-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 o If yes, you may need to contact Historic 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.
Description of work .10t — Hof hDt-t$•c A
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I 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 know that a
permit is not valid until it has been paid and issued:
Applicant: �r.
Print Name: r1P Signature
Date y y
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