HomeMy WebLinkAbout931 Arbor Ave - Applications/Reroof - 05/13/2014Planning, Development&Transportation
F6City of 281 N. College Ave P.O. Box 580
p^ !, Collins Fort Collins, CO 80524
/00"� Phone 970-416-2740 Fax 2245134
OVER—THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement Aloofing ❑ Sewer Line 0 Photo -voltaic
• Ventilation ❑ Water Heater O 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 f 13—/
For oltice use only
Job Site Address (required) Value of Construction (labor, materials, profit)
� 3 ( 4-/% o a. 4vt ]$S-00
Property Owner Name Address
City/State
Zip
Phone
L,e n/,4 ' 4 I l) e2 guff 31 4ELa/L 4-ve
27— $ .3�
Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
City/State
Zip
Phone `_Y10
`'_ac:��-er- •� C:� .e. y�8 �.L,�
11�r�� ��L �
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Contractor City of FL Collins Sales Tax # U I -tnL/,
Are you paying taxes here or by report? ❑ Here J4 Report
Sales tax number isregdr dbyallrnnbactrms.
Are you paying with your trust account? 0 Yes
❑ No
Is this a" residential or commercial project? TA Residential ❑ Commercial
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) 59 Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church 0 Hotel/Motel ❑ Medical office 0 office
O Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes `FkNo If yes, you may need to contact Hisionc Preservation
If this is for a demolition permit, what year was the building constructed?
If prlor to 1975, you will need an asbestos assessment to submit with this application.
Description of work 7E4-/L- Xy o t- o t-t 7-D 0 G� Ke Plums vy
P_A&Wtvh fhw�il�
*If lawn sprinkler/baclflow preventer, must list licensed plumber. If first-time A/C, must list licensed
Subcontractors: List the company name or Gty of Ft Collins license #
Elecb idan 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: -.JF� Print Name: Signature
Date `r I Y T