HomeMy WebLinkAbout1118 Timber Ln - Applications/Reroof - 06/11/2014307-638-3887
11:46:21 06-11-2014 1/1
City of Planning, Development & Transportation
281 N, College Ave P.O. Box 580
Fort Cot li n s Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS 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 ❑ Roofing ❑ 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 accepted.
Application it 1314020 Y1 Date Du 11. 2.014
Forofllce use only
Job Site Address (requ/red)
Value of Construction (labor, materials, profit)
77
Property Owner Name
Address
Clty/state Zip Phone
XJL
q-10.2i3•g2°I
Applicant Name
Address
Clty/State Zip Phone
�.[►-wLitpi
Contractor
Address
City/State Zip Phone
307 'Q38
a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here 0 Report
5a/estaxnumber isrequiredbyall canladors:
Are you paying with your trust account? ❑ Yes Jffi No
Is this a residential or colnmerclal project? , residential ❑ Commercial
If residential, is it: 6FSingle Family Detached 13 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 ❑ No If yes, you may need to Contact Hs7nric Preservation
If this Is for a demolition permit, what year was the building constructed? .
Ifprior to 1975, you w!/1 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/back low preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ustthe company name ort7tyo/RCoUins/Icense jr S�,prv1�`•`— 327
Bectridan Plumber Mechanical
Roofer - 2:2 4 O Other
1 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 city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: /
Print Name&nh01-4,z lwe Signature J6>rs �4n `_Date
.—