HomeMy WebLinkAbout4416 Monte Carlo Pl - Applications/Reroof - 08/05/2014of
Fort COltins
Planning, 0mlopment & Transportation
281 N. College Ave P.Q. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Afteradon (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ PhotoAoolteic
❑ Ventilation d Water Heater ❑ Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and /A
manufacturer). vzl�
complete all applicable inforrmatioonon the applon. incomplete applications will not be accepted.
Application #�D S `SW Date �" l
For afte UW onN
lob Sibs Address Oegarred)
Value of construction (low, materials, prom)
rr
Property Owner Name.
Address
City/St�aatte` Zip
Phone
Applicant Name
Address
City/State Tip
Phone
-r— u ti
- ld
Contractor
Address
city/state Zip
Phone
l
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
W Here 0 Report
S Stax isreprdmdbyaNawrtrscrars
Are you paying with your trust acoount?
0 Yes iM No
Is this a residential or commercial project? 9 Residential 0 Comme cW
If residential, is It: 4111' Single Family Detaclu d ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, Is It: ❑ Bank ❑ Bar 17 Church ❑ Hotel/Motel 0 Medical office 0 office 0 Retail
O Restaurant 17 Other (explain)
Is this building 50 years of age or more? O Yes O No gye& you rhaynsed to cnnhxtHbtDdc Phesww t*orr
If this Is for a demolitlon penrdt, what year was the building consbvcted?
A`pnt r to 1975, you wiunefed an asbeslar az essment to submff wrdr this apialkaaon.
tra.
lawn sprinlder/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcanbadorm L/st the w npany name arOty Oft CaSk s &wtsmg 0
Eledridan Plumber Medani®I Roofer
• ,17
I hereby acknowledge that I have read this application and state that the above Information is oomplete and oorrecL I agree to
comply with all requirements contained herein and city ordinances and sIe laws regulating building conatruc ion. I know thiat a
permit Is not valid until It has been paid and issued.
Print Nlame:�- //14 Signahire