HomeMy WebLinkAbout4417 S Timberline Rd - Applications/Reroof - 03/13/2012City.
of Planning, Development & Transportation
aCol
`J" 281 N. College Ave P.O. Box Sao
FVI ` ColtinFort 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 nonstructural) ❑.Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 19 Roofing 0 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 # Y IAy ` IT 1
For o8la rue only
Date ),S- J 3
Job Site Address (Saq\uired)
Value of Construction (labor, materials, profit)
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f-f°perty Owner Name Address
City/state Zip
Phone
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Applicant Name Address
Gty/State Zip
Phone
Contractor Address
City/state .Zip
Phone
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9 q1-4Q11
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
® Here ❑ Report
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Are you paying with your trust account?
® Yes ❑ No
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Is this a residential or commercial project? ■ Residential ❑ Commercial
If residential, is it: ® 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 § No Ifyiss, you may need to contact Hcsiar/cPres Mbbn
If this is for a demolition permit, what year was the building constructed?
Ifprfor to 1975, you will need an asbestos assessment to subm/t w10 drls appl/cdtlorr.
Description of work
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*If lawn sprinider/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: LW Me company name or CYy of ft Collins //tense' 0
Hed3idan_ Plumber Mechanical Roafer R� Other
I hereby acknowledge that I have read this application and state that the ab5ve information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating budding constructlon. I know that a
permit is not valid until It has been paid and issued.
Applicant: Lj_ —�a qJ 7
Print Name: '\6�Ct`� n2� gnature "' — Dale
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