HomeMy WebLinkAbout412 Towhee St - Applications/Reroof - 07/18/2014Planning, Development & Transportation
C� City of 281 N. College Ave P.O. Box 580
�t Collins Fort Collins, CO 80524
Phone 970416-2740 Fax 224-6134
�l l o •'ram
OVER-THE-COUNTER PERMITS ONLY
This application is to he 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 ❑ Sewar 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 # 1514-040151 Date
For office use only
Sob Site Address (required)
zx'�a
Value of Construction (labor, materials, profit)
,
Pro Owner Name
Address
City/State Zip Phone
Y tom„
9.z5�—
rc� s-- f 7( -
Applicant Name
Address
/state Zip Phone
Contractor
Address
City/state Zip Phone
r� � n
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? B Here ❑ Report
Wes Wnuro&r/Srw edbya//amvadors
Are you paying with your trust account? ❑ Yes 40 No
Is this a residential or commercial project? Iitesidential ❑ Commercial
If residential, is it: 40Single Family Detached ❑ Condo/townhome (single family attached) E3 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Moth) ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant O Other (explain)
Is this building 50 years of age or more? ❑ Yes D No If yes, you may need to contact Hlst0c Preservation
If this is for a demolition permit, what year was the building constructed?
lfpdor ro.W75, you tut11 need an ashRstos assessment to submit with this applicafion.
Description of work
*If lawn sprinkler/back low preventer, must fist Itoensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or City ofFtCOX=lkense 0
Eledridan Plumber Mechanical Roofer Other
I hereby admawledge 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 mnstrudaon. I know that a
permit is not valid until it has been paid and Issued.
Applicant. ^�"- -4 / iC~�
print Name: u Signature r �� Date