HomeMy WebLinkAbout1221 Dewey Dr - Applications/Reroof - 01/10/2012City of Planning, Development & Transportation
F6r"t Collins
o1� s For N. College Ave P.O. Box 580
+�a1i°r Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVERmTHE=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
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 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 #\2oO�_ DateFor ofte use only
Job Site Address (required) Value of Construction (labor, materials, profit)
122.1 e rr , 2600• 00
Property Owner Name
Address
City/State Zip
Phone
Fir
122( Dewey L1,
R. Call;os Co W5X
aa01-78Y
Applicant Name
Address
City/State Zip
Phone
l Idiv\
i I5
d CO 9053
647-(247
Contractor
Lic # Address
City/State Zip
Phone
S cry, Cooff n4
- 19 S<if)e
Contractor City of Ft.
ins Sales Tax #
Are you paying taxes here or by report?
1� Here 0 Report
.Sales tour number is required by all contractors
Are you paying with your trust account?
0 Yes X No
Is this a residential or commercial project? 0) Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O 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? ❑ Yes 19 No If yes, you may need to contact Hkitoric 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 applxabba
Of
*If fawn sprinkler/backflow preventer, must fist licensed plumber. If first-time A/C, must fist licensed electrician -
Subcontractors: List the company name or City of ft Collins license #
FJecb idan Number,
Mechanical Roofer. Other
I hereby acknowledge that I have read this appitation 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: T 1 — 10 —' Z
Print Name: ` )e V_ i l l SignatureDate -