HomeMy WebLinkAbout1716 Morningside Dr - Applications/Reroof - 03/16/2012city.p f Planning,, Development It Transportation
�Or+� CO���ns 281 N. College Ave P.O. Box S80
�� ll �.►V J Fort Collins, CD 80524
Phone 970416-2740 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). O Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gee Lighter ❑ Gas Log
D Heating Unit 0 Lawn Sprinkler O Mobile Flom® replacement gMofing ❑Sewer Line O Photo-voltak
❑ Ventilation D Water Heater ❑ Water Line D Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Corn0k" all applicable Information on the application_
Application * 1�3 V 2-0 V'6 �
Finer of lie cae only
Job Site Address &Wubed)
Owner Name Address
Name Address
Name
/zo/ red
Contractor DX646Aj Lic # Address
f2n IiC/< <.44.,,
Contractor Qty of R. Collins Sales Tax #
SbAks tax numberis ra" dbyall M0&3 m
Incomplete OPPlkatlona will not to accepted.
Date — —12-
e? ell
Value of Construction (labor, materials, profit)
$ 2 yG�.
Gty/State Zip Phone
city/ate Zip Phone
Zip Phone
Are you paying taxes here or by report? IB'glere D Report
Are you paying with your trust account? O yes D No
Is this a residential or commercial pro)ect7 Wokesidentlal 0 Commercial
If residential, Is It: O Single Family Detached ❑ Condo/townhome (single family attached) jg Duplex
O Multifamily (apartment) ❑ Garage
If commercial, Is It: D Bank D Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office E3 Retail
D Restaurant D Other (explain)
Is this building SO years of age or more? O yes A No If yes, yew may need to cvnbct/f/�� p
If this Is for a demolition permit, what year was the building constructed? mervabbn
Ifpnbr tO 1975, you *If need an asbesms anent to submit w1t h this ape//piton.
Description of work
*If lawn sprInkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subconbeotors: Ust ble company nerve or GIy ofpr Colft flch nse f
Bectridan Mumber. Mechanical Roofer —&nEL _ Other ice_
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 cky ordinances and state laws regulating building construction. I know that ■
Permit is rwt valid until It has been paid and issued.
r
Applicant:
Print Nam: Signature
Date —/2