HomeMy WebLinkAbout3749 Bromley Dr - Applications/Reroof - 07/21/2014Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 00524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following penults 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 4 Sewer Line M Photo -voltaic
Q Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable infnmtation on the application.
Application #1!5 b 4 0 qc'�5®
For office use only
Incomplete applications will n be accepted.
Date' ��i1 141 -03
Sob Site Address required)/
Value of Construction (labor, materials, profit)
lZa
in!
7k,
Property Owner Name
Address
City/State ZipVA Phone
Ti�{"Ib.iS
Appll�nt Name
Address
Gty/State ZIP Phone
Con ctor
Address
City/State Zip Phone
f`TitY` I0'- - & &
!OW r
3L POg
Contractor City of Ft. Collins Sales
Tax #
Are you paying taxes here or by report? 10mere ❑ Report
+lesa�+•iamb=•4JayuntalbydnfunlroWm
Are you paying with your trust account? a Yes ❑ No
Is this a residential or commercial project? ;KResidential ❑ Commercial
If residential, is It: FtgiSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Bank 13 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office A Office 13 Retail
17 Restaurant CI Other (explain)
Is this building So years of age or more? ❑ Yes L7 No If yes, you may need to contact Historic Pmservation
If this is for a demolition permit, what year was the building constructed?
Ypnor to 19i5, you will need an asbestos a«UnAnt to submit with this appllcadon.
*If lawn sprinWer/badcFlow preventer, must list licensed plumber. If first-time A/c, must Ilsl) licensed electrician.
Subcontractors. Ust the company name or City of Ft co/l/ns lkensd #
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:
Print Name . 1✓ Signatur S Date
10/10 39dd 9NId00N QNOWVIQ a3a L90008ZE0E TZ:TZ bTOZ/0Z/LO