HomeMy WebLinkAbout2613 Antelope Rd - Applications/Reroof - 08/12/2014%.IYY of
c� Mann -
Ong' ®evelo
/®��o�y� Mann-
Ong'281 M. College Ave
P Pent et Transportation
�g S Fort Collins, CO 80524 O. Box 580
s Phone 970-416-2740 Fax 224-6134
®��RsIriE-Co N�
This application ( as to foe used to a R PERMITS ONLY
um
� Demolition (interior non-structural PptY for the g®tt®ryin
❑ Heating Unit , ) Cl Electrical Alteration (notmits service o(ha� (check
all that a
g Lawn Sprinkler ❑ Mobile Home replacement Pghte Air Conditioning
❑ Ventilation ❑Water h�e^�ter 9) O Gas Lighter ❑ Gas Log
manufacturer}, Water Line C7 VVood/Pellet Stove �(ms p be ECPAwea Photo -voltaic
Complete all appljc+rrblia irOf®rmation ®a0 the a certified, Provide make, model and
Application #�so 60ag application. Incomplete applications will not be accepted.
For orfl, a use only - ---- Date l --
Job Site 6ldd
(�4uired) -r---
L-=-L � 3
Property Ovvner Nam(
e "�
Applicant Name =�-"
Contractor
e galete 01 ConstruCtion (labor, materials, profit)
--__ I S (c� o
Address City/Stag-
I SC1.me> Zip SOj Z.v Phone 9
Address Gty/State (29 Z - WV
Zip Phone
Contractor City of Ft. Collins Sales Tau #
Sales Pax number is rffquired by a// contractors A,li
Address ao , `�=>
City/State Zip
Are you paying taxes here or by report?
Are you paying with your trust account?
Phone
Cl Here ❑ Report
O Yes J No
Is this a residential or 0 fnercial project? Residential ❑ Codal
If residential, is it: U- single Family Detached 0 Condo/townhome (single family attached) ® Duplex
Mcalf�Ifarnily (apartment) ® Garage P
If commercial, is is Z1 Bank ® gar ❑ Church ❑ Hotel/Motel ®O
❑Medics! office Office ® Retail
Q Reslzurant ® Other (explain) _
Is this building SO VDAIM QG Qqa or more? ❑ Yes ❑ No If es If this Is for a Jc.walEUQfi PQr mit, what year was the building constructed? �r��d to contact ifistonc Prnsertaf/on
IfPnor to -11.975, you will need an asbestos assessment to submit with this app/icadort, --'
Description of wore c-c��"
*If lawn sprinkler/bads low preventer, must list licensed Plumber. If first-time A/C, must list licensed electrician,
Subconb-.wtom; Is/ r/;E cnn oany name or City of Ft Collins license A+LI
ElecWdan___`_ — Plumber
Mechanical` Roafer�PiB 29 d tc Other
I hereby acknowledge tha':1 have read this application and state that the above infoemation is complete and correct. I agree to
comply with all requirement, contained herein and city ordinances and state laws regulating building construction. I know that a
permit Is not valid untig §L hay been paid and Issued.
Applicant.
Print Name:
---____ Signature