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HomeMy WebLinkAbout4207 Fall River Dr - Applications/Reroof - 08/08/2014Cof Fort Collins Planningr Development & Transportatjon 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 I 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 Conclitioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Cl Gas Lighter ❑ Gas Ldg ❑ Heating Unit ❑ Lawn Sprinkler C Mobile Home replacement , TRoofng ❑ Sewer Line ❑ Photo-vot4c ❑ Ventilation ❑ Water Heater ❑ Water Line 0 Woad/Pellet Stove (must be EPA certified, provide make., r cdei and manufacturer). Complete all applicable information on the applicatiom incomplete appli s will not be accepted., Application # ..E2l405 (1(0 9 Date SrSTI For ofike use only Job- Site Address (regrorad) Value of Construction (labor, materials, ; Property Owner Name Address City/State ZIP c7C, P+ Applicant Name Address city/State Zip Phone "S)y #ZLijc ,2A. Z-S 76 Co Contractor I.fC Address city/state Zip Phone :antra City of Ft. Ccdhs Sales Tax # Are you paying taxes here or by report? ,H'Here C Report Fares tax rrmnba-JsreV radbya#mn&aebr-- Are you paying whit your trust account? E3 Yes 11 No I •s this a residential or commercial project? .lRestdenttal © Commerdal f residential, is it ;a0fingie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) Q Garage ! f commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail i 0 Restaurant ❑ Other (explain) s this building 50 years cf age or more? ❑ Yes 9'No Ifyes, you may need to ceatad Historic Preservabcn, this is for a demolition permit, what year was the building constructed? fprrcr to 1975, you will need an asbestces assessment to submit with this apprcaden. I I I iescription afwor'.cjert i ply— EXiSi, cg3eD(ALi:- ��'stI c��,�5 'rruNYVS I If lawn sprinklerlbacfclow preventer, must Est licensed plumber. If first-time A(C, must fist icensed dectrician. ubcontractors: Ust the mmaa-nynarne ori2yofFr Colrns license A I I ectridan Humber Mechanical Roofer Other I i i ieraby adawwledge that I have read this application and state that the above information is axnplete and correct I agree to imply wi& all requirements contained herein and city ardinances and state laws regulating building construction. I knowlthat a srmit Is not valid until it has been paid and issued. I 3piicant. ,�_ ` l `t \ I int Name. i� �`��y P, SignatureDate l 1 L•d £6L"99-OL6 uoBeled