HomeMy WebLinkAbout3019 Eastborough Dr - Applications/Reroof - 05/14/2012Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. sox sac 5
Collins,
Phone 970-41616-27402740 Fax 224-6134 �
OVER-THE-COUNTER PERMITS ONLY I �a
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 XRoofing ❑ 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 # /o-o Date N N l av
For office use only In ^
lob Site Address (required)
30/q e
L -r r
Value of (Construction (labor, materials, profit)
�i $ SOOO
Property Owner Name
Address Gty/State Zip Phone
cvii is '4? 30
1��60 C.0 gos
303•
Applicant Name
UfteMIMM
Address City/State Zip Phone
zsro +aqbavc. vMW9GW4 qgq-gets
Contractor
Address a� City/State Zip Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? )&ere Report
.salesrax nu er ,edbyalirnnbwdW3� Are you paying with your trust account? ❑ Yes
Is this a residential or commercial project? P12tesidential ❑ Commercial
If residential, is it: ❑ 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 Wo 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 asNzWs assessment to submit witfi this applxation.
Of
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed etectriclan.
Subcontractors: tlst the company nano or Gty of Ft Collins license A +�tQ
Electrician plumber. Mechanical Roofer �`�+"aa/ Other
I hereby acknowledge that I have read this application and state that
comply with all requirements contained herein and city ordinances an
permit is not valid until it has been paid and issued. ,
Applicant:
Ne information is complete and correct. I agree to
laws gtyulating building construction. I know that a