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HomeMy WebLinkAbout5208 Parkway Cir - Applications/Reroof - 07/21/2014Fart C;othns PIanning; DOwellojimMit & Transportation 281 N. College Ave P.O. Box SW Fort Collims,'GO 80524 Phone 970 41Crr274U Fax 229-613n OVER THE-COYNTER PERMITS ONLY Thie application is to be used to apply for the following permits only (check all that apply), O Air Conditioning El Demolition (interior non-structural) 0 Electrical (Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 01 Roofing, ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation 0 Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). 1 Complete all applicable Information on the application. Incomplete applicattone will not be accepted. Application # Date For office usa only ]ob Site Address (,uqLffmd), Value of Ckinstruction (labor, materials, profit) �o�s ca .73 Property Owner Name Address City/State Zip Phone Ge�� aK.�� Svc" �+_ f0s, 2S Applicant Name Address ! I City/State zip Phone Contractor Address City/State Zip Phone Woo t�. GAl e'j6t-q'Ns, 84539 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ® Here ❑ Report ��s�,rnu„�cr is dbya//ror acmr i i Are you paying with your trust account? 0 Yes Cl No Is this a residential or commercial project? 11 Residential C7 Commercial If residential, is it: ® Single Family Detached [3 Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) A Garage. If commercial, is it; ❑ Sank ❑ Bar ❑ Church q Hotel/Motel ❑ Medicei'oBlee 0 Oflice ❑ Retail ❑ Restaurant Ci Other (explain) is this building SQ years of age or more? O Yes : No Ifyw, you mayrwd to Ca tw t Hlsft*PYesawdbn If this is for a demolition permit, what year was the: building oonstnxbed? If prior to 1975, you will need an asbestx a-zeoueritto su&mt xm thisappllcadon. Description of work *If lawn sprinlder/baddiow preventer, must fist licensed bIumben.. if first-time AX, must list lk eased electrician. Subcontractors: Lst the mmp anynanre or ray ofFt GbJtinslr�ru� ©edyidan Plumber Medianical Roofer 51Q Other I hereby actmowtedge that I have read this application a#d state that the above InkmMtlon is complete and correct I agree to comply with all requirements contained herein and city otdirwroes and state laws regulating building construction. I know that a Permit is not valid until it has been paid and il. Applicant - Print Print Name., � Ui- . I