HomeMy WebLinkAbout3013 Pleasant Valley Rd - Applications/Reroof - 03/22/2012To: 19702246134 From: Ashley McLain 3-22-12 7:54am p. 2 of 5
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F(5rt C®limn Fort Collins, CO 80524
`..� Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERT ITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical. Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoofing ❑ 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 acc*ed.
Application # Datel`d
For Wc6 use only
Job Site Address (required) Value of Construction (labor, materials, proflt)
3D
- l smo
Property Owner Name
rye �I k�ex
Address city/State Zip Phone
3013 Pie rS'aY�i �a it �'d . 1.1 l'nz5 abZ�7
Applicant Name
AAdddres�sy / City/State / Zipp�� s'�jPhhone."S'
majila
Contractor
Nowc
Address City/State Zip Phone "W
Zs-11D LOS*AVC . VQAVW ft2oO# ZOO-IL03
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? >Here ❑ Report
❑ Yes )lo
Sales tax �)vd by all contractors. Are you paying with your trust account?
Is this a residential or commercial project? residential ❑ Commercial
If residential, is it: 'Noingle 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 *pMo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Of
*If lawn sprinkler/backftow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: List the company name or Gty of Ft Collins license ,F Q®
Electrician Plumber Mechanical Roofer'_ Other
I hereby acknowledge that I have read this application and state that the ove information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances an a laws ryyulating building construction. II know that a
permit is not valid until it has been paid and issued. Y/
Applicant: __1a2
Print Name,�ua�AKsignature lDate __