HomeMy WebLinkAbout381 Aurora Way - Applications/Reroof - 04/04/2012City Of Planning, Development & Transportation
c Y 281 N. College Ave P.O. Box 580
_rOrt Collins Fort Collins, 16 27504
/^� Phone 970-416-2740 Fax 224-6134 ^�
1
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 0 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 # +� 21� Date
For ofce use only 1 5 \
Job Site Address (required)
Value of Construction (labor, materials, profit)
381 n D v Wa,
FT. vLUNs)CO 00. C) v
Property Owner Name
Address
City/State Zip
Phone
XrNT Gu?LcIz- v�RO R
WADI `• COLLINS CD 52
(49o)Hh-13-?3to
Applicant Name
Address-
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
At L PPASL
?355
C-,ttt2N ZIWIE RD vi)mtSort Co aoSSSO
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? a Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes 9•No
30017-1 5-4 (,
Is this a residential or commercial project? 19 Residential ❑ Commercial
If residential, is it: W Single 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber
Mechanical Roofer Y 51`\ 2513 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: ,0�^ ^ (� «�� Signature
Date
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