HomeMy WebLinkAbout5751 Ballina Ct - Applications/Reroof - 01/25/2012Jan, 25- 2012 10:37AM Bob B e h r e n d s Roofing
No,5813 P. 2/3
fit f of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
t CollTyr, s Fort Collins, CO 80524
Phone 970416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be useukto apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-strruturaq ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
p Heating Unit ❑ Lawn SprhMer Cl Mobile Home replacement 1$ Roofing ❑ Sewer Line O Photo -voltaic
❑ Ventilation ❑ Water Heater ❑: Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable infaanation on the application. Incomplete applications will not be accepted..
Application # `2. n0�'0 Date
For office tere m
Job Site Address (requireY) G� �C� Value of Construction (labor, materials, profit)
Properly Owner Name
Address
City/State
Zip
Phone
�r
Applicant Name
Address
City/State
Zip
Phone
r
u.-A
Contractor #
Address)
City/State
Zip
Phone
rc�Lic
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Contractor City of Ft. Collins sAA
Tax #
Are you paying taxes here or by report? I$ Here
❑ Report
Sales tax number Isrequlredbyasaxa==rs
y\ '�)14
Are you paying with your trust account? Yes
[I No
Is this a residential or comrnen3tproject? Residential ❑ Commercial
If'resldenGal, is it; A5ngleTamlly Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ MultlawYg (apartment) ❑ Garage
If commercial, is it: ❑ Bark n Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
. ❑ Restautan ❑ Other (explain)
Is this building 50 years of ageor more? 0 Yes Am Dyes, you mayneed to contact Historic Preservatlon
If this is for a demolition pertst,. what year was the building constructed?
If prior to 1975, you wf/i need avasbestos assessment to submit PlAh this application.
work
*If lawn sprinkler/backflow preveger, must list licensed plumber. If first=time A/C, must list licensed electrician.
Subcontractors: List the compaayname or oty of Ft Collins license #
Electrician Plucriier Mechanical Roofer — \1 Other
I hereby acknowledge that I havewad this application and state that the above information is complete and correct. I agree to
comply with all requirements cont3hedherein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it bas Seen paid and Issued.
,applicant:
Print Signaivre �� ��y�k���e `, Dater