HomeMy WebLinkAbout2608 Tulane Dr - Applications/Reroof - 03/14/2012Mar.14. 2012 8:36AM Bob Behrends Roofini;
No.6416 P. 2
fit;/ of -
�t Collins
Planning, Development & Transportation
281- N. College Ave P,O. Box S80
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). l7 Air Conditioning
❑ Demolition (interior non-staztural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Spr►tkler ❑ Mobile Home replacement %Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation ❑ Water Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applic le M ocn ti n o a placation. Incomplete applications will not be accepted.
DOW
Application # z Ld I LAMDate
For ice!M mdy
Job Site Address (require-d) Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State
Zip Phone
cA
Applicant Name
Address
City/State
Zip Phone
lD\
S�
r� -
Ob 3`15_ a o
Contractor I.ic #
Address
Clbj/State
Zip Phone
Co. 110v3> 39 S- 04(1
Contractor City of Ft. Collins SAA Tax #
Are you paying taxes here or by report? Here ❑ Report
Are with trust account? XYes ❑ No
sales tax number ismquimdbyaffconaadors
you paying your
Is this a residential or commecU project? X Residential ❑ Commercial
If residential, is it: --t'34inglefiamlly Detached. O Condo/townhome (single family attached) ❑ Duplex
❑ Multifaw'ly (apartment) ❑ Garage
If commercial, is it ❑ Bank 115 Bar ❑ Church 13 Hotel/Motel [3 Medical office ❑ Office ❑ Retail
❑ Restaurmt. ❑ Other (e laln)
is this building 50 years of ageor more? [IYes No Ifyes, .you mayneed to contact HistancPreservadon
if this Is for a demolition germs. what year was the building constructed?
If prior to 1975, you will nead anasbestos assessment to submit w1th this application.
Description of work
C-
4'
*If lawn sprinkler/bac)diow prevei:Mr, must list licensed plumber. If first-time A/C, must fist licensed
Subcontractors: List the ccm mg name or City of ft Collins license 0
Electrldan plurn*r Mechanical Roofer 1� Other
I hereby acknowledge that I have mad this application and state that the above information is complete and correct- I agree to
comply with all requirements conned 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.
An_p:p,.laicant:
tug.-o. \nQk ._ \Dai2