Loading...
HomeMy WebLinkAbout1528 W Lake St - Applications/Reroof - 05/28/2014a of Plonnfng, Dveopment&Transp ortation N. Ave P.O. Box 580 t CoLtins Fort Collins OD 80524-phone 970416-274d Fax 224-6134 +OVERwTHE-COUNTER PERMITS ONLY This application Is to be used to apply for the following permits only (check all that apply). 0 Air Canditiontng ❑ Demolition (mterior nan-structural) CI Electrical Alteration (not service change) a Gas,Ughter 0 Gas Log ❑ Heating Unit 13 Lawn Spdnkler ❑ Mobile Home replacement Aoding I] Sewor Line ❑ Photo-voltsio ❑ Venb7atlon CQ Water Heater ❑ Water Line ❑ Wood/Pellet Stave (must be EPA oeii&ed, provide make, model and manufacturer). Complete all applicable information on the application. incomplete applications will not be accepted. Appilcadan #_ 51 4021310For ame 1W a* job Site Address (raw/ ftV value of Construction (labor, materials, praM 5 e ! 4616o,jj.3Qo Pro erty Owner Name Address city Ilp • 9 Phone J atr41C e � -?6 dv9 Applicant Name Address U city/Slate ap Phone denJ (2y.4Z2M z i/Na - #5 eeg/oua Contractor Address city/State Zip Phone slit �ifsia �ar7 IY !-'.0,&K,2Z?&7 /g645- 2406,04Q7 970 YPa'`l/ Contractor City of FL Collins SelesTax # Are you paying taxes here or by reportPKHere ❑ Report aW ara=6wkraVRedbya®cbntOMm Are you paying with your trust account? 3KYSS ❑ No Is this a residential or commensal prafect? yXResidential 0 Commercial If residential, is It 'A Engle Famiy DetacMd ❑ Condoftownhome (single family atfaehed) 0 Duplex 0 t>Dfamiy (apartment) C7 Garage If commensal, is It: 0 Hank ❑ Bar 0 Church 0 Hotel/Motel ❑ Medical office ❑ office ❑ Retail ❑ Restaurant 0 oth r (explain) Is this bWkiing 50 years of ega or more7�est ClNo 1f yo' yaw maynead to aid f bbdcPrrs>°rp &n If this is for a demolition permit, wh r was the building oonstructed? ,Vpdor to 197S, yow wll/nead an aabesfas amEswz rrt to submit wf& fft app/kabhrx *If fawn 5pdnkier/badcflow pmventLr, must list licensed plumber. If first-time A/C, must list RoVi5ed deadclan, SubrontowUrs: Lfttftmmpanynameort]IyofptCbl4ruGcerfse, S Plumber Medumikel Roofer Other_ I hereby adawwledge that I have mad this apOlcatlon and state that the above Irdermationis complete and correct, I agree to campy wlth all regWrerne fts contained herein and city ordinances and state laws regulating to lillpg construction. ; know that permit is trot valid until S has been paid and issued.