HomeMy WebLinkAbout1815 Mesaview Ln - Applications/Reroof - 03/02/2012City f Planning, Development & Transportation
F�— y o281 N. College Ave P.O. Box 580
6rt Collins Fort Collins, CO 80524
\..- 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 Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement W/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 a application.
Application # ?AZ-OC)`
For office use only
Incomplete applications will not be accepted.
Date Mt6q 2, ZOIZ
Job Site Address (required) Value of Construction (labor, materials, profit)
/(&16' rhES4 VICE LA*e 1 $
Property Owner Name Address
City/State
Zip
Phone
D-&Ff Cof "Prn.o 1815
/"v/LTCott1PJ Co.
o5_2G
Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
City/State
Zip
Phone
64kl(5 COP7214-c7710& UA,
10VGZ';' t (2O.
80S3
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: X) Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ,V No If yes, you may need to contact Historic 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 application.
Description of work / e?VE a2 s'/�i,�►6 LEI /,V f 7
BELT- L G Wn C f /LfZ f7 O /1/Z6r
OF 1 A47n1 A)!!4' Shy, z�znr
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # /1 /, n
Electrician N �% Plumber �- Mechanical fy//-f Roofer 4 `Okr 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: {{��
Print Name: EOSW % c'rylynl
Date 2 y