HomeMy WebLinkAbout2909 Stonehaven Dr - Applications/Reroof - 07/23/2014Fort Collins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ARoofing ❑ 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 '# a M O q5-W Date J V, y a31 ao (4
For office use only
Sob Site Address (required)
Value of Construction Qabor, materials, profit)
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Property Owner Name Address
Gty/State Zip Phone
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Applicant Name Address
City/State Zip Phone
MICHAOL SLAOW-Mg 7.17.0 CwsflopseTWA
Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? XHere ❑ Report
sales tar numbrrIsreputmdbyall conbadm
Are you paying with your trust account? AYes ❑ No
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Is this a residential or commercial project? 00 Residential ❑ Commercial
If residential, is it: 6a Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex n
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 yearsof age or more? ❑ Yes Pt No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
work
*If lawn sprinkler/bacldlow preventer, must listgi2ensed plumber. If first-timeWC, must list licensed electrician.
Subcontractors: List the company name or O?y of R Collins iicense # R 91,;� %C%
Electrician Plumber Mechanical Roofer Other
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 city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: - _ � � Z3
Print Name: In Signature Date