HomeMy WebLinkAbout2780 Canby Way - Applications/Reroof - 08/15/2014Aug,15, 2014 7:23PM Bob Behrends Roofing No.2117 P. 7/12
City of
PlaotnInor DevelopMent It Transportation
281 N. College -Ave P.O. Box $80
Fort Collins, CO 80524 ' '
Phone 970-416-2740 Fak 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application 1s to be ussilita apply for the following permits only (cheok all that apply). ❑ Air Conditioning*. .
❑ Demolition (Interior non-strworal) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Ci Gas Log
❑ Heating Unit ❑ Lawn Spriatiar ❑ Mobile Home replacement IX Roofing ❑ Sewer Line, C) Photo-voltalo
M Ventilation ❑ Water Heater D Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
.•manufagturer).
'Complete all -applicable linjoynation-on the jatpplllcation. 'Incomplete eppiications \will not be accepted.
APPll :aiion" #t . (L� l� l/ 11 Ij �� -Date --- -11
�or'otr�C2 all
Sob Site Address (mquIlvd) Value of Construction (labor, materials, profit)
$ +�
.Property Owner Name Address
.City/State -Zip
Phone
^^
Applicant Namq Address
City/State Zip
; phone
Contractor Lis # Address
City/State ZIP
Phone
r (
Ci Ob
395-046
Contractor City of Ft. Collins Tax #
Are you paying taxes he a or by report?
gHere p Report
selasbxnumberfsrepuuedbyel�acmrr..
'A\ t� �� _
Are. you paying with your trust account?
Yes ❑ No
Is this a residental or mrerMpro)ect?---eldential M Commecial�
Ifrestdential;Isit ..�"ePlanlly Detached 0 "d-
Condo/townhome (single family attached) ❑ Duplex
M Mult9hW(apartment) M Garage
If commercial, Is it: ' ❑ Bank 93 Bar to Church ❑ Hotel/Motel ❑ Mtdical office CI.Office ❑ Retail
❑ Restaunrat. ' ❑ other (explain) .
is this building 6o years of w9ser more? t7 Yes �INo 0yes irou may need to contact HA o&P.reservat/on
If this'is.far a demolltlon petaf,what .year.wa-s-{Fe Ullding constructed? • • . •
0pr/or to 3975, you W11 needasas6estas assessment to submlt wll/l thls application. •
of work
*If lawn 5pnnkier/backflow-prevwer, mah-list licensed plumber. If first time A/C, must list licensed electrician, `; (.5h
subcontractors, Llsf the compaWam i? or M of It Co/Onsl/cense 0l� F J
Electrldan' Plur,hr, Mechanical_ Hoofer � a, other ^ T ••
I herebq'acknowledge that I haveeaad this application and state thattthe above Information Is complete and correct: I agree to
comply with all requirements corMed herein and city, ordinances acid state laws regulating building construction. x know that e
permit is not valid until It hasllpAn paid and issued.-